Materiały źródłowe

• #1 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Approximately 10% of patients report an allergy to penicillin however up to 90% of these patients do not have a true allergy. […] The incidence of anaphylaxis to penicillin is 0.02% to 0.04% and is mediated by a type 1 hypersensitivity reaction. Overall, cutaneous eruptions are the most commonly reported reaction. IgE antibodies decrease over time. In patients who have previously tested positive for penicillin allergy, there is an expected 10% decrease/year of a subsequent positive reaction. Therefore, with the avoidance of PCN, 80% to 100% of patients will ultimately test negative for penicillin allergy 10 years after the initial positive test. The presence of an underlying bacterial or viral infection with penicillin administration also often resulted in false reporting of penicillin allergies such as the exanthem seen with EBV.

• #2 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Prevalence of reported allergy to penicillin is approximately 10% among the U.S. population and higher among hospital inpatients and residents in health care-related facilities. […] One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another -lactam antibiotic allergy. […] The prevalence of reported penicillin allergy in low-income countries is unknown; however, limited data indicate that penicillin is one of the most frequently reported antibiotic allergies. […] The overreported prevalence of penicillin allergy is secondary to imprecise use of the term allergy by families and clinicians and lack of clarity to differentiate between immunoglobulin E (IgE)-mediated hypersensitivity reactions, drug intolerances, and other idiosyncratic reactions that can occur days after exposure.

• #3 Penicillin allergy: Immediate reactions – UpToDate

  https://www.uptodate.com/contents/penicillin-allergy-immediate-reactions

  Penicillin allergy is the most commonly reported medication allergy. Up to 10 percent of all patients and 15 percent of hospitalized patients report some type of penicillin allergy. […] The epidemiology, risk factors, diagnosis, and management of immediate reactions to penicillins will be discussed here.

• #4 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  10% of U.S. patients report having a penicillin allergy, but less than 1% of the population is truly allergic. […] However, many patients who report penicillin allergies do not have true IgE-mediated reactions. When evaluated, fewer than 1% of the population are truly allergic to penicillins. […] Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics. […] Broad-spectrum antibiotics are often used as an alternative to penicillins. The use of broad-spectrum antibiotics in patients labeled „penicillin-allergic” is associated with higher healthcare costs, increased risk for antimicrobial resistance, and suboptimal antibiotic therapy. […] Broad-spectrum antibiotics can increase healthcare costs and antimicrobial resistance, and your patient may receive less than the best care. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #5 Penicillin Allergy FAQ

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/penicillin-allergy-faq

  Approximately 10% of patients report an allergy to penicillin. However, the majority of patients (greater than 90%) may not truly be allergic. […] Even if you think you are allergic to penicillin, allergies change over time and it is worth discussing your history with your allergist / immunologist who may suggest an evaluation to help clarify your allergy history. […] The decision of whether you need to carry epinephrine should be made after specialty consultation with your allergist / immunologist. In general, it is not recommended that patients who have a history of penicillin allergy carry epinephrine. […] Drug allergy expert Allison Ramsey, MD, FAAAAI, discusses the importance of proactively delabeling patients with reported penicillin allergy. This is a must listen for all healthcare professionals and relevant to at least 10% of the general population.

• #6 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Prevalence of reported allergy to penicillin is approximately 10% among the U.S. population and higher among hospital inpatients and residents in health care-related facilities. […] One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another -lactam antibiotic allergy. […] The prevalence of reported penicillin allergy in low-income countries is unknown; however, limited data indicate that penicillin is one of the most frequently reported antibiotic allergies. […] The overreported prevalence of penicillin allergy is secondary to imprecise use of the term allergy by families and clinicians and lack of clarity to differentiate between immunoglobulin E (IgE)-mediated hypersensitivity reactions, drug intolerances, and other idiosyncratic reactions that can occur days after exposure.

• #7 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another -lactam antibiotic had an objective positive test for penicillin allergy. […] Moreover, in studies that have incorporated penicillin skin testing and graded oral challenge among persons with reported penicillin allergy, the true rates of allergy are low, ranging from 1.5% to 6.1%. […] In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%9.0%. […] Among persons with confirmed IgE-mediated penicillin allergy, the level of cross-reactivity with third-generation cephalosporins is low. […] If a patient has a low-risk history for an IgE-mediated penicillin allergy, ambulatory settings often treat with third-generation cephalosporins without further testing.

• #8 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another -lactam antibiotic had an objective positive test for penicillin allergy. […] Moreover, in studies that have incorporated penicillin skin testing and graded oral challenge among persons with reported penicillin allergy, the true rates of allergy are low, ranging from 1.5% to 6.1%. […] In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%9.0%. […] Among persons with confirmed IgE-mediated penicillin allergy, the level of cross-reactivity with third-generation cephalosporins is low. […] If a patient has a low-risk history for an IgE-mediated penicillin allergy, ambulatory settings often treat with third-generation cephalosporins without further testing.

• #9 Penicillin Allergy Prevalence Greater in High-Income vs. Middle-Income Nations

  https://www.hcplive.com/view/penicillin-allergy-prevalence-greater-high-income-vs-middle-income-nations

  High-income countries show a 9.9% penicillin allergy prevalence, significantly higher than middle-income countries’ 4.4%. […] A study found penicillin allergy prevalence is higher in high-income countries (9.9%) than in middle-income ones (4.4%), highlighting disparities in reporting and research. […] Notably, as has been described previously, we found very little data from outside high-income countries, and we only found a single study published from a low-middle-income country and none from low-income country. […] The global prevalence of penicillin allergy was 9.4% (95% confidence interval [CI], 8.4 10.4%). High-income countries had a 9.9% prevalence of penicillin allergy (95% CI, 8.7 11.0%), which was significantly greater than the 4.4% penicillin allergy prevalence in middle-income countries (95% CI, 2.8 6.2%) (P .0001).

• #10 Penicillin Allergy Prevalence Greater in High-Income vs. Middle-Income Nations

  https://www.hcplive.com/view/penicillin-allergy-prevalence-greater-high-income-vs-middle-income-nations

  Investigators wrote the low data on penicillin allergy prevalence in certain continents, such as Africa, Asia, and South America, may suggest penicillin allergy in these places has a lower burden and thus receives less research. […] Countries where English is the primary language had prevalence levels of 10%; no other countries reached this prevalence. […] The study observed that the method of allergy recording significantly impacted the reported prevalence. […] Furthermore, few studies were conducted in primary care (6.5%; 95% CI, 0.2 20.5%) compared with secondary care (10.2%; 9.2% – 11.3%). […] Still, primary care research is underrepresented in the literature.

• #11 The global prevalence of reported penicillin allergy: A systematic review and meta-analysis – EM consulte

  https://www.em-consulte.com/article/1723967/the-global-prevalence-of-reported-penicillin-aller

  We establish that the global prevalence of reported penicillin allergy is 94%. Most data (72%) are derived from three HICs, USA, UK and Australia. HICs had higher prevalence rates than MICs, with no data from LICs. Only 3% of studies focussed solely on primary care. Inter-study variance is influence by methodology, with lower prevalence in studies utilising coded data vs medical records.

• #12 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  A 2019 study in England reported 5.9% of patients have a penicillin allergy recorded on their health record. […] However, fewer than 10% of these patients are likely to have a true allergy to penicillin. […] In a 2014 US study, penicillin-allergic hospital patients were found to have 23.4% more C. difficile and 14.1% more MRSA infections than expected compared with control subjects. […] This means that up to four million people across the UK may have an incorrect allergy status record, putting them at increased risk of harm. […] In a 2019 US study involving 11.1 million patients, a recorded penicillin allergy was associated with a 14% increased risk of death. […] Once a penicillin allergy is recorded, patients receive less effective and/or more toxic antibiotics for subsequent infections.

• #13 Penicillin allergy: a practical approach to assessment and prescribing – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing.html

  Penicillin allergies are not always lifelong. Approximately 50% are lost over five years. A reaction to penicillin during a childhood infection is unlikely to be a true allergy. […] In the USA, penicillin allergies are the most commonly documented drug allergy, with up to 20% of hospitalised patients having a recorded penicillin allergy. […] In Australian hospitals, national point prevalence data (201314) show that 8.9% of patients have a penicillin allergy label on their medical record. […] A high proportion of these labels are likely to be incorrect. […] Patient-reported penicillin allergies alter antibiotic management and may result in the use of suboptimal or broader spectrum drugs such as fluoroquinolones, macrolides, glycopeptides and cephalosporins. […] Having a penicillin allergy label has been associated with an increased risk of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci infections and colonisation.

• #14 De-labelling penicillin allergy in acutely hospitalized patients: a pilot study | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06794-1

  Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. […] The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. […] The prevalence of penicillin allergy in the hospital records in our medical department inpatient population was 4.6%. This is lower than expected, as the prevalence of penicillin allergy is commonly reported to be around 10%. […] A true IgE-type allergy was unlikely in 45% of the self-reported penicillin allergic patients, due to an interview algorithm. […] Our study also shows that a direct oral amoxicillin challenge is an easy and a safe way to rule out penicillin allergy in acutely hospitalized patients, when carefully selected. 98% of the tested patients had no immediate reaction.

• #15 The global prevalence of reported penicillin allergy: A systematic review and meta-analysis – EM consulte

  https://www.em-consulte.com/article/1723967/the-global-prevalence-of-reported-penicillin-aller

  The global prevalence of reported penicillin allergy: A systematic review and meta-analysis – 13/02/25 […] Patients labelled with penicillin allergy (PenA) often receive broader spectrum antibiotics, associated with antimicrobial resistance and poorer outcomes. However, 95% of patients are likely mis-labelled. […] Here, we address the global prevalence of PenA, to inform the wider potential impact for de-labelling programmes. […] Global PenA prevalence was 94% (95% CI 84104%). […] HICs had higher PenA prevalence 99% (95% CI 88110%), compared to middle-income countries (MICs), 44% (95% CI 2862%), p0.0001. […] Studies reporting PenA prevalence are skewed towards HICs and secondary care, with little data from Africa, most of Asia and South America. This highlights an unmet need to broaden epidemiological analysis in under-represented regions.

• #16 Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/challenges-and-opportunities-related-to-penicillin-allergy-in-the-veterans-health-administration-a-narrative-review/F0ED96021ECB279D6F442B49235E19B4

  The presence of a penicillin allergy label in a patients medical chart is associated with negative clinical and economic outcomes. […] Given that less than 10% of reported reactions are truly immunoglobulin E-mediated, removal of unverified penicillin allergy labels is a public health priority and an area of ongoing implementation research. […] The prevalence of allergies to penicillin-class antibiotics among inpatients at non-VHA facilities/systems ranges between 9% and 15%, and the literature suggests that this is similar within VHA facilities. […] They found allergy to one or more members of the penicillin-class of antibiotics to be the most frequently reported (13%), followed by opiates (9.1%), angiotensin-converting enzyme (ACE) inhibitors (5.7%), and sulfonamides (5.1%). […] Importantly, and in contrast to non-VHA health system studies, we found no multisite VHA facility studies examining the impact of penicillin or -lactam allergy labels on hospital length of stay, mortality, and adverse outcomes for specific infections in the veteran population.

• #17 Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4210656/

  Penicillin allergy remains the most common drug allergy, with a reported prevalence of 10% in the United States. […] Epidemiology of penicillin allergy in outpatient populations is relatively scarce. […] Of the 11,761 patients seen in the clinic, 1348 patients (11.5%) reported a history of penicillin allergy. […] There was an increased prevalence of penicillin allergy in female patients compared with male patients (odds ratio [OR] = 1.82; 95% CI = 1.60, 2.08; p 0.0001), and there were significantly fewer Asians with penicillin allergy compared with Caucasians (OR = 0.51; 95% CI = 0.32, 0.83; p = 0.007). […] Overall, improved referral to an allergist will help to identify patients who have penicillin allergy requiring avoidance. […] It is therefore important to study the epidemiology of penicillin allergy, because it may help practitioners better identify the patients at risk for true drug allergy.

• #18

  https://bpac.org.nz/bpj/2015/june/allergy.aspx

  Beta-lactam antibiotic allergy is reported twice as frequently in females than in males, although this may be explained by higher antibiotic use by females in this age group. It is uncertain whether a history of atopy or a family history of antibiotic allergy increases a persons risk of antibiotic allergy. A small study analysed risk factors in 62 patients who attended allergy clinics in the United States, of whom 23 had documented penicillin allergy and 39 were age, gender and ethnicity matched controls who had tolerated penicillin. Multivariate analysis showed that a history of penicillin allergy in a first-degree relative and a history of allergy to other medicines were significant risk factors for penicillin allergy. Penicillin allergy was associated with a history of atopy, but this was not statistically significant in the multivariate model. Limitations of this study included the sample size and whether patients attending an allergy clinic were a representative population. Further research is needed in this area to provide definitive answers.

• #19 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  It is important that the term penicillin allergy is correctly applied to avoid adverse effects or inappropriate treatment. […] Repeated exposure to antibacterials, for example in medical conditions that require frequent antibacterial use such as cystic fibrosis, is recognised as a clinical risk factor for penicillin allergy. […] Female sex has been identified as a risk factor in adults for both self reported and confirmed penicillin allergy, possibly related to greater antibacterial use in women. […] The prevalence of penicillin allergy appears to increase with age.

• #20 Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4210656/

  Penicillin allergy remains the most common drug allergy, with a reported prevalence of 10% in the United States. […] Epidemiology of penicillin allergy in outpatient populations is relatively scarce. […] Of the 11,761 patients seen in the clinic, 1348 patients (11.5%) reported a history of penicillin allergy. […] There was an increased prevalence of penicillin allergy in female patients compared with male patients (odds ratio [OR] = 1.82; 95% CI = 1.60, 2.08; p 0.0001), and there were significantly fewer Asians with penicillin allergy compared with Caucasians (OR = 0.51; 95% CI = 0.32, 0.83; p = 0.007). […] Overall, improved referral to an allergist will help to identify patients who have penicillin allergy requiring avoidance. […] It is therefore important to study the epidemiology of penicillin allergy, because it may help practitioners better identify the patients at risk for true drug allergy.

• #21 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  It is important that the term penicillin allergy is correctly applied to avoid adverse effects or inappropriate treatment. […] Repeated exposure to antibacterials, for example in medical conditions that require frequent antibacterial use such as cystic fibrosis, is recognised as a clinical risk factor for penicillin allergy. […] Female sex has been identified as a risk factor in adults for both self reported and confirmed penicillin allergy, possibly related to greater antibacterial use in women. […] The prevalence of penicillin allergy appears to increase with age.

• #22 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  It is important that the term penicillin allergy is correctly applied to avoid adverse effects or inappropriate treatment. […] Repeated exposure to antibacterials, for example in medical conditions that require frequent antibacterial use such as cystic fibrosis, is recognised as a clinical risk factor for penicillin allergy. […] Female sex has been identified as a risk factor in adults for both self reported and confirmed penicillin allergy, possibly related to greater antibacterial use in women. […] The prevalence of penicillin allergy appears to increase with age.

• #23

  https://bpac.org.nz/bpj/2015/june/allergy.aspx

  Beta-lactam antibiotic allergy is reported twice as frequently in females than in males, although this may be explained by higher antibiotic use by females in this age group. It is uncertain whether a history of atopy or a family history of antibiotic allergy increases a persons risk of antibiotic allergy. A small study analysed risk factors in 62 patients who attended allergy clinics in the United States, of whom 23 had documented penicillin allergy and 39 were age, gender and ethnicity matched controls who had tolerated penicillin. Multivariate analysis showed that a history of penicillin allergy in a first-degree relative and a history of allergy to other medicines were significant risk factors for penicillin allergy. Penicillin allergy was associated with a history of atopy, but this was not statistically significant in the multivariate model. Limitations of this study included the sample size and whether patients attending an allergy clinic were a representative population. Further research is needed in this area to provide definitive answers.

• #24

  https://bpac.org.nz/bpj/2015/june/allergy.aspx

  Beta-lactam antibiotic allergy is reported twice as frequently in females than in males, although this may be explained by higher antibiotic use by females in this age group. It is uncertain whether a history of atopy or a family history of antibiotic allergy increases a persons risk of antibiotic allergy. A small study analysed risk factors in 62 patients who attended allergy clinics in the United States, of whom 23 had documented penicillin allergy and 39 were age, gender and ethnicity matched controls who had tolerated penicillin. Multivariate analysis showed that a history of penicillin allergy in a first-degree relative and a history of allergy to other medicines were significant risk factors for penicillin allergy. Penicillin allergy was associated with a history of atopy, but this was not statistically significant in the multivariate model. Limitations of this study included the sample size and whether patients attending an allergy clinic were a representative population. Further research is needed in this area to provide definitive answers.

• #25 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. […] Research has shown that penicillin allergies may be over-reported a problem that can result in the use of less-appropriate and more-expensive antibiotic treatments. Therefore, an accurate diagnosis is needed when penicillin allergy is suspected to ensure the best treatment options in the future. […] Penicillin allergy occurs when your immune system becomes hypersensitive to the drug mistakenly reacting to the drug as a harmful substance, as if it were a viral or bacterial infection. […] Previous exposure to penicillin may not be obvious. Some evidence suggests that trace amounts of it in the food supply may be sufficient for a person’s immune system to create an antibody to it. […] While anyone can have an allergic reaction to penicillin, a few factors can increase your risk. These include: A history of other allergies, such as food allergy or hay fever; Allergic reaction to another drug; A family history of drug allergy; Increased exposure to penicillin, because of high doses, repetitive use or prolonged use; Certain illnesses commonly associated with allergic drug reactions, such as infection with human immunodeficiency virus (HIV) or the Epstein-Barr virus.

• #26 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. […] Research has shown that penicillin allergies may be over-reported a problem that can result in the use of less-appropriate and more-expensive antibiotic treatments. Therefore, an accurate diagnosis is needed when penicillin allergy is suspected to ensure the best treatment options in the future. […] Penicillin allergy occurs when your immune system becomes hypersensitive to the drug mistakenly reacting to the drug as a harmful substance, as if it were a viral or bacterial infection. […] Previous exposure to penicillin may not be obvious. Some evidence suggests that trace amounts of it in the food supply may be sufficient for a person’s immune system to create an antibody to it. […] While anyone can have an allergic reaction to penicillin, a few factors can increase your risk. These include: A history of other allergies, such as food allergy or hay fever; Allergic reaction to another drug; A family history of drug allergy; Increased exposure to penicillin, because of high doses, repetitive use or prolonged use; Certain illnesses commonly associated with allergic drug reactions, such as infection with human immunodeficiency virus (HIV) or the Epstein-Barr virus.

• #27 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Approximately 10% of patients report an allergy to penicillin however up to 90% of these patients do not have a true allergy. […] The incidence of anaphylaxis to penicillin is 0.02% to 0.04% and is mediated by a type 1 hypersensitivity reaction. Overall, cutaneous eruptions are the most commonly reported reaction. IgE antibodies decrease over time. In patients who have previously tested positive for penicillin allergy, there is an expected 10% decrease/year of a subsequent positive reaction. Therefore, with the avoidance of PCN, 80% to 100% of patients will ultimately test negative for penicillin allergy 10 years after the initial positive test. The presence of an underlying bacterial or viral infection with penicillin administration also often resulted in false reporting of penicillin allergies such as the exanthem seen with EBV.

• #28 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Approximately 10% of patients report an allergy to penicillin however up to 90% of these patients do not have a true allergy. […] The incidence of anaphylaxis to penicillin is 0.02% to 0.04% and is mediated by a type 1 hypersensitivity reaction. Overall, cutaneous eruptions are the most commonly reported reaction. IgE antibodies decrease over time. In patients who have previously tested positive for penicillin allergy, there is an expected 10% decrease/year of a subsequent positive reaction. Therefore, with the avoidance of PCN, 80% to 100% of patients will ultimately test negative for penicillin allergy 10 years after the initial positive test. The presence of an underlying bacterial or viral infection with penicillin administration also often resulted in false reporting of penicillin allergies such as the exanthem seen with EBV.

• #29 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Approximately 10% of patients report an allergy to penicillin however up to 90% of these patients do not have a true allergy. […] The incidence of anaphylaxis to penicillin is 0.02% to 0.04% and is mediated by a type 1 hypersensitivity reaction. Overall, cutaneous eruptions are the most commonly reported reaction. IgE antibodies decrease over time. In patients who have previously tested positive for penicillin allergy, there is an expected 10% decrease/year of a subsequent positive reaction. Therefore, with the avoidance of PCN, 80% to 100% of patients will ultimately test negative for penicillin allergy 10 years after the initial positive test. The presence of an underlying bacterial or viral infection with penicillin administration also often resulted in false reporting of penicillin allergies such as the exanthem seen with EBV.

• #30 SciELO Brazil – Allergy to penicillin and betalactam antibiotics Allergy to penicillin and betalactam antibiotics

  https://www.scielo.br/j/eins/a/DqckCyJcVWVxNXVSrDjFqfz/

  Epidemiological studies demonstrated the past history of penicillin allergy was reported by about 10% of population who attended healthcare services, and approximately 1.3% reported a history of cephalosporin allergy. […] However, when correctly evaluated, only 10% of those who reported penicillin allergy had positive skin tests for the drugs involved, and less than 5% were truly allergic. […] The incidence of IgE-mediated and non IgE-mediated reactions has not increased worldwide over the last 50 years, and a penicillin allergy label has significant consequences for individual and public health. […] Longitudinal studies from a center in the United States showed the rate of positive penicillin skin tests decreased from 15%, in 1995, to 3%, in 2007, and to 0.8%, in 2013. […] In Latin America, a multinational survey showed that BL are the second drug class most associated with hypersensitivity reactions, ranking behind nonsteroidal anti-inflammatory drugs (NSAID). […] Similarly, when only drug-induced anaphylaxis was investigated in Latin America, BL ranked second, also behind NSAID.

• #31 Penicillin allergy: a practical approach to assessment and prescribing – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing.html

  The increased use of broad-spectrum drugs in hospitalised patients with penicillin allergies also contributes to the growing global problem of antimicrobial resistance. […] Antibiotic allergy labels are correlated with increases in length of hospital stay, hospital readmission rates, surgical site infections, and admissions to intensive care units. […] Similarly in general practice, penicillin allergy labels are associated with an increased risk of death and MRSA infection or colonisation. […] It has been demonstrated that more than 90% of patients labelled as having a penicillin allergy would be able to tolerate penicillins following appropriate assessment and allergy testing. […] Even penicillin allergies confirmed by skin tests can wane over time. […] Half the patients who have a positive skin test for penicillins will lose that reactivity after five years.

• #32 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Correctly identifying those who are not allergic can improve antibiotic prescribing and combat the risk of super-bugs by allowing patients access to safer, less toxic antibiotics. […] According to the CDC, approximately 80 percent of patients with a penicillin allergy lose their sensitivity after 10 years. […] Today, we have skin test methods to help identify patients who may be genuinely penicillin-allergic and those who are not.

• #33 Practical guide for evaluation and management of beta-lactam allergy: position statement from the Canadian Society of Allergy and Clinical Immunology | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00494-2

  The over-labelling of beta-lactam allergy is associated with increased costs and antimicrobial resistance; testing for beta-lactam allergy would be 9.5 times less expensive than treating an in-patient population with an alternative antimicrobial. […] For these reasons, removal the penicillin allergy label (delabeling) is recommended by multiple organizations, including the American Academy of Allergy, Asthma, and Immunology, the Infectious Disease Society of America, Canadian Pediatric Society, lInstitut National dExcellence en Sant et en Services Sociaux (INESSS) in Quebec, Choosing Wisely Canada, and the Centers for Disease Control and Prevention. […] The label of beta-lactam allergy is common, affecting 10% of the population, and carries with it a risk of negative clinical and socioeconomic outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increased rates of antibiotic-resistant infections, and greater medical costs.

• #34 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  10% of U.S. patients report having a penicillin allergy, but less than 1% of the population is truly allergic. […] However, many patients who report penicillin allergies do not have true IgE-mediated reactions. When evaluated, fewer than 1% of the population are truly allergic to penicillins. […] Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics. […] Broad-spectrum antibiotics are often used as an alternative to penicillins. The use of broad-spectrum antibiotics in patients labeled „penicillin-allergic” is associated with higher healthcare costs, increased risk for antimicrobial resistance, and suboptimal antibiotic therapy. […] Broad-spectrum antibiotics can increase healthcare costs and antimicrobial resistance, and your patient may receive less than the best care. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #35 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  A 2019 study in England reported 5.9% of patients have a penicillin allergy recorded on their health record. […] However, fewer than 10% of these patients are likely to have a true allergy to penicillin. […] In a 2014 US study, penicillin-allergic hospital patients were found to have 23.4% more C. difficile and 14.1% more MRSA infections than expected compared with control subjects. […] This means that up to four million people across the UK may have an incorrect allergy status record, putting them at increased risk of harm. […] In a 2019 US study involving 11.1 million patients, a recorded penicillin allergy was associated with a 14% increased risk of death. […] Once a penicillin allergy is recorded, patients receive less effective and/or more toxic antibiotics for subsequent infections.

• #36 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #37 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #38 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  10% of U.S. patients report having a penicillin allergy, but less than 1% of the population is truly allergic. […] However, many patients who report penicillin allergies do not have true IgE-mediated reactions. When evaluated, fewer than 1% of the population are truly allergic to penicillins. […] Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics. […] Broad-spectrum antibiotics are often used as an alternative to penicillins. The use of broad-spectrum antibiotics in patients labeled „penicillin-allergic” is associated with higher healthcare costs, increased risk for antimicrobial resistance, and suboptimal antibiotic therapy. […] Broad-spectrum antibiotics can increase healthcare costs and antimicrobial resistance, and your patient may receive less than the best care. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #39 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Correctly identifying those who are not actually allergic can improve antibiotic prescribing and combat the risk of super-bugs by allowing patients access to safer, less toxic antibiotics. […] There is a causal relationship between inappropriate antimicrobial use and resistance; changes in antimicrobial use lead to parallel changes in the prevalence of resistance.

• #40 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #41 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #42 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #43 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #44 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #45 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #46 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #47 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #48 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  A 2019 study in England reported 5.9% of patients have a penicillin allergy recorded on their health record. […] However, fewer than 10% of these patients are likely to have a true allergy to penicillin. […] In a 2014 US study, penicillin-allergic hospital patients were found to have 23.4% more C. difficile and 14.1% more MRSA infections than expected compared with control subjects. […] This means that up to four million people across the UK may have an incorrect allergy status record, putting them at increased risk of harm. […] In a 2019 US study involving 11.1 million patients, a recorded penicillin allergy was associated with a 14% increased risk of death. […] Once a penicillin allergy is recorded, patients receive less effective and/or more toxic antibiotics for subsequent infections.

• #49 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #50 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Did you know that the vast majority of individuals who think they have a penicillin allergy dont? Its true! Penicillin is the most commonly reported drug allergy in the United States, but 9 out of 10 patients who report a penicillin allergy arent truly allergic. […] Inaccurate diagnosis of penicillin allergy can adversely impact medical costs for both patients and healthcare systems: research shows that antibiotic costs for patients reporting penicillin allergies are up to 63% higher than for those who do not report being penicillin-allergic. […] Patients labeled penicillin-allergic may have a threefold increased risk of adverse events (ADE). […] In the hospital setting, a history of penicillin allergy translates to about 10% more hospital days, 30% higher incidence of VRE infections, 23% higher incidence of C difficile infections, and 14% higher incidence of MRSA infections.

• #51 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  A 2019 study in England reported 5.9% of patients have a penicillin allergy recorded on their health record. […] However, fewer than 10% of these patients are likely to have a true allergy to penicillin. […] In a 2014 US study, penicillin-allergic hospital patients were found to have 23.4% more C. difficile and 14.1% more MRSA infections than expected compared with control subjects. […] This means that up to four million people across the UK may have an incorrect allergy status record, putting them at increased risk of harm. […] In a 2019 US study involving 11.1 million patients, a recorded penicillin allergy was associated with a 14% increased risk of death. […] Once a penicillin allergy is recorded, patients receive less effective and/or more toxic antibiotics for subsequent infections.

• #52 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  A 2019 study in England reported 5.9% of patients have a penicillin allergy recorded on their health record. […] However, fewer than 10% of these patients are likely to have a true allergy to penicillin. […] In a 2014 US study, penicillin-allergic hospital patients were found to have 23.4% more C. difficile and 14.1% more MRSA infections than expected compared with control subjects. […] This means that up to four million people across the UK may have an incorrect allergy status record, putting them at increased risk of harm. […] In a 2019 US study involving 11.1 million patients, a recorded penicillin allergy was associated with a 14% increased risk of death. […] Once a penicillin allergy is recorded, patients receive less effective and/or more toxic antibiotics for subsequent infections.

• #53 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  Hospitalized patients with documented beta-lactam allergies are more likely to experience inferior outcomes, treatment failures, adverse events, and healthcare-associated infections. […] In patients diagnosed with bacterial pneumonia, a penicillin allergy label is associated with an 11% increase in ICU admission and 8% increase in mortality compared to patients without a penicillin allergy label. […] Patients with a penicillin allergy record were six times more likely to be prescribed meropenem than patients without a penicillin allergy record, increasing the selection pressure for the emergence and spread of multiresistant bacteria. […] More healthcare associated infections: alternatives to penicillins tend to be broader-spectrum antibiotics. This both increases the risk of multi-drug resistance developing and causes increased collateral damage to the microbiota of the skin and intestines, associated with higher rates of MRSA carriage and Clostridioides difficile infection in patients with a penicillin allergy label.

• #54 High-Cost, High-Need Patients: The Impact of Reported Penicillin Allergy

  https://www.ajmc.com/view/highcost-highneed-patients-the-impact-of-reported-penicillin-allergy

  A reported penicillin allergy was common and was associated with suboptimal antibiotic choices and increased healthcare utilization in high-cost, high-need patients. […] More than 90% of patients who report a penicillin allergy have the allergy disproved when tested. […] We described the prevalence and impact of a reported penicillin allergy in high-cost, high-need (HCHN) patients. […] Of 1870 HCHN patients, 383 (20%) reported penicillin allergy, 835 (45%) had MDIS, and 290 (16%) had both. […] HCHN patients reporting penicillin allergy had an increased odds of beta-lactam alternative antibiotic use (adjusted odds ratio, 3.84; 95% CI, 2.17-6.80). […] HRU was significantly higher for patients reporting a penicillin allergy alone (adjusted relative risk [aRR], 1.13; 95% CI, 1.03-1.25) and with concurrent MDIS (aRR, 1.20; 95% CI, 1.08-1.34).

• #55 High-Cost, High-Need Patients: The Impact of Reported Penicillin Allergy

  https://www.ajmc.com/view/highcost-highneed-patients-the-impact-of-reported-penicillin-allergy

  A reported penicillin allergy conferred a 4-fold increased odds of beta-lactam alternative antibiotic use. […] Reporting penicillin allergy, with and without MDIS, was associated with significantly more HRU. […] The HCHN patients had a markedly high prevalence of reported penicillin allergy (20%). […] Penicillin allergy testing removes false penicillin allergy labels in more than 90% of patients who carry a historical penicillin allergy diagnosis. […] The resistant organisms MRSA and VRE were surprisingly uncommon in HCHN patients (4%). […] A reported penicillin allergy in HCHN patients was associated with a 7-fold lower use of narrow-spectrum beta-lactams and a more than 3-fold increased use of alternative antibiotics. […] Although all patients were high utilizers, reporting a penicillin allergy, both alone and with concurrent MDIS, conferred a 10% to 20% significant increase in HRU. […] This large, retrospective cohort analysis demonstrates that there is a high burden of drug allergy in HCHN patients and substantial room for improvement in the antibiotic choices made for HCHN patients reporting a penicillin allergy.

• #56 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  Penicillin allergy is the most commonly reported drug allergy. […] It is estimated that between 10% and up to 20% of those reporting penicillin allergy are truly allergic. […] Prescription of a penicillin to patients with a previous allergy-like event after penicillin treatment is common and could result in serious harm or death. […] The diagnostic workup for penicillin allergy includes clinical history, skin tests, in vitro testing, and drug provocation tests. […] Penicillin allergy is a potentially serious adverse reaction that alters and reduces the options for antibacterial treatment, and which can be life threatening. […] It is the most commonly noted drug allergy in the UK, reported by about 10% of the population. […] It is estimated, however, that only around 20% of those reporting penicillin allergy are truly allergic.

• #57

  https://link.springer.com/article/10.1007/s11882-014-0476-y

  Penicillin is the most common beta-lactam antibiotic allergy and the most common drug class allergy, reported in about 8 % of individuals using health care in the USA. […] Most reported penicillin allergy is not associated with clinically significant IgE-mediated reactions after penicillin rechallenge. […] Un-verified penicillin allergy is a significant and growing public health problem. […] Clinically significant IgE-mediated penicillin allergy can be safely confirmed or refuted using skin testing with penicilloyl-poly-lysine and native penicillin G and, if skin test is negative, an oral amoxicillin challenge. […] Acute tolerance of an oral therapeutic dose of a penicillin class antibiotic is the current gold standard test for a lack of clinically significant IgE-mediated penicillin allergy.

• #58 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  Penicillin allergy is the most commonly reported drug allergy. […] It is estimated that between 10% and up to 20% of those reporting penicillin allergy are truly allergic. […] Prescription of a penicillin to patients with a previous allergy-like event after penicillin treatment is common and could result in serious harm or death. […] The diagnostic workup for penicillin allergy includes clinical history, skin tests, in vitro testing, and drug provocation tests. […] Penicillin allergy is a potentially serious adverse reaction that alters and reduces the options for antibacterial treatment, and which can be life threatening. […] It is the most commonly noted drug allergy in the UK, reported by about 10% of the population. […] It is estimated, however, that only around 20% of those reporting penicillin allergy are truly allergic.

• #59

  https://link.springer.com/article/10.1007/s11882-014-0476-y

  Penicillin is the most common beta-lactam antibiotic allergy and the most common drug class allergy, reported in about 8 % of individuals using health care in the USA. […] Most reported penicillin allergy is not associated with clinically significant IgE-mediated reactions after penicillin rechallenge. […] Un-verified penicillin allergy is a significant and growing public health problem. […] Clinically significant IgE-mediated penicillin allergy can be safely confirmed or refuted using skin testing with penicilloyl-poly-lysine and native penicillin G and, if skin test is negative, an oral amoxicillin challenge. […] Acute tolerance of an oral therapeutic dose of a penicillin class antibiotic is the current gold standard test for a lack of clinically significant IgE-mediated penicillin allergy.

• #60 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/afp/2021/0615/p760.html

  Penicillin allergy is the most commonly documented drug allergy in medical records, with a prevalence of approximately 10% of all patients.1 However, in up to 90% of patients with a reported allergy, penicillins are tolerated on allergy testing.2 […] A formal drug challenge is the preferred test for investigating immunoglobulin E-mediated penicillin hypersensitivity (type I hypersensitivity)4; skin testing is also a commonly used validated tool.1 […] Despite the high prevalence of patients labeled as having a penicillin allergy, there is an international shortage of those proficient in conducting formal drug challenges.5 […] A more recent study derived and validated a clinical prediction rule for penicillin allergy.8 The PEN-FAST (penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment) rule was derived from a prospective cohort of 622 allergy-tested patients in Melbourne, Australia, using a multivariable logistic regression model.

• #61 De-labelling penicillin allergy in acutely hospitalized patients: a pilot study | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06794-1

  Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. […] The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. […] The prevalence of penicillin allergy in the hospital records in our medical department inpatient population was 4.6%. This is lower than expected, as the prevalence of penicillin allergy is commonly reported to be around 10%. […] A true IgE-type allergy was unlikely in 45% of the self-reported penicillin allergic patients, due to an interview algorithm. […] Our study also shows that a direct oral amoxicillin challenge is an easy and a safe way to rule out penicillin allergy in acutely hospitalized patients, when carefully selected. 98% of the tested patients had no immediate reaction.

• #62 Penicillin Allergy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459320/

  Cross-reactivity with other penicillin-related compounds, specifically cephalosporins, has resulted in the avoidance of drug use. Early studies may have also over-estimated cross-reactivity between penicillin and cephalosporins as the production of early generation cephalosporins may have been contaminated with small amounts of penicillin. Penicillin has a single R side chain whereas cephalosporins have two. If the penicillin side chain is similar to either cephalosporin side chain, there is a greater risk of cross-reactivity. This more commonly occurs with first and second generation cephalosporins than with third or fourth generation cephalosporins making the latter more attractive treatment choices when a patient has a proven penicillin allergy. Overall, cross-reactivity with aminopenicillins is less than 2%, carbapenems less than 1% and cephalosporins less than 3%. There is no significant reported cross-reactivity with monobactams.

• #63 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another -lactam antibiotic had an objective positive test for penicillin allergy. […] Moreover, in studies that have incorporated penicillin skin testing and graded oral challenge among persons with reported penicillin allergy, the true rates of allergy are low, ranging from 1.5% to 6.1%. […] In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%9.0%. […] Among persons with confirmed IgE-mediated penicillin allergy, the level of cross-reactivity with third-generation cephalosporins is low. […] If a patient has a low-risk history for an IgE-mediated penicillin allergy, ambulatory settings often treat with third-generation cephalosporins without further testing.

• #64 Study describes global prevalence of reported penicillin allergy | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/study-describes-global-prevalence-reported-penicillin-allergy

  A systematic review and meta-analysis finds that the global prevalence of reported penicillin allergy (PenA) is nearly 10%, though much of the data come from high-income countries (HICs), researchers reported late last week in the Journal of Infection. […] In the 124 full-text, peer-reviewed studies included in the meta-analysis, worldwide prevalence of PenA was 9.4%. Prevalence in HICs (9.9%) was more than twice that of middle-income countries (4.4%). […] „This highlights an unmet need to broaden epidemiological analysis in under-represented regions,” the study authors wrote. […] The findings are noteworthy because research has shown that 95% of people labeled as having PenA are mislabeled and can tolerate penicillins, which are the preferred first-line antibiotics for over 95% of infections, according to the World Health Organization (WHO). […] Given that the WHO has endorsed antibiotic allergy assessment as an important antimicrobial stewardship activity, the authors say more research is needed on penicillin allergy labels in LMICs and LICs.

• #65

  https://link.springer.com/article/10.1007/s12016-024-08988-2

  Despite being done in some areas of the World like Chinese mainland, where due to regulation an intradermal test is routinely performed before using penicillins, or frequently before BPG administration for ARF prevention, according to 40% of respondents of an African health worker survey, routine penicillin allergy testing in individuals without reported allergy and requiring therapy with a penicillin is not usually recommended due to the very low rate of anaphylaxis. […] Removing incorrect penicillin allergy labels (i.e., penicillin allergy delabeling) is of importance to improve antimicrobial stewardship practices worldwide. […] Our systematic review showed that using PST or direct DC in low-risk individuals with history of penicillin allergy was safe as we did not observe any cases of anaphylaxis, death, or other severe adverse reactions with these approaches. […] Direct oral DC among people with a penicillin allergy label seems to be safe, with severe reactions observed only very rarely. Presence of trained healthcare professionals prevented any fatalities.

• #66 Penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and antimicrobial resistance (ALABAMA): protocol for a multicentre, parallel-arm, open-label, randomised pragmatic trial | BMJ Open

  https://bmjopen.bmj.com/content/13/9/e072253

  The ALlergy AntiBiotics And Microbial resistance (ALABAMA) trial (full title: penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and AMR) will evaluate participants randomised to either usual care or to receive Penicillin Allergy Assessment Pathway (PAAP). […] This trial aims to address the large discrepancy between reported and true allergy rates and will determine if introducing pre-emptive testing for patients who are more likely to receive antibiotics in the future, could impact on antibiotic prescribing, yield patient benefits, limit AMR/healthcare associated infection and deliver NHS cost savings.

• #67 The Penicillin Allergy Conundrum — NUEM Blog

  https://www.nuemblog.com/blog/penicillin-allergy

  Penicillin allergy is the most commonly reported allergy in the United States with a prevalence of up to 12.8% of the population. […] While this may seem inconsequential, recent data suggest patients with reported penicillin allergies have increased hospital length of stay and increased risks of clostridium difficile, vancomycin resistant enterococcus, and MRSA infections. […] We know that of patients who report a penicillin allergy, 90% are able to tolerate penicillin. […] In one prevalence study, only 6% of patients reporting penicillin allergy were referred for allergy testing. […] If the patient is being admitted to the hospital, consider inpatient testing for IgE mediated hypersensitivity as this has been shown to decrease both inpatient complications and cost of care. […] The actual cross-sensitivity between penicillins and cephalosporins is considered much lower than originally proposed when cephalosporins were first marketed in the 1960s.

• #68

  http://www.bccdc.ca/about/news-stories/stories/penicillin-allergies-are-rarer-than-you-think

  Penicillin allergy is reported in approximately 10 per cent of pregnant women, but when evaluated appropriately, 90 per cent of these patients can safely receive penicillin because they do not have a true allergy or they have outgrown the allergy. […] Less than five in 10,000 people have a true serious allergy to penicillin. […] One in 100 experience adverse effects. […] Research shows that individuals labelled as penicillin-allergic suffer more adverse effects and are at greater risk for C. difficile infection.

• #69 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/afp/2021/0615/p760.html

  Penicillin allergy is the most commonly documented drug allergy in medical records, with a prevalence of approximately 10% of all patients.1 However, in up to 90% of patients with a reported allergy, penicillins are tolerated on allergy testing.2 […] A formal drug challenge is the preferred test for investigating immunoglobulin E-mediated penicillin hypersensitivity (type I hypersensitivity)4; skin testing is also a commonly used validated tool.1 […] Despite the high prevalence of patients labeled as having a penicillin allergy, there is an international shortage of those proficient in conducting formal drug challenges.5 […] A more recent study derived and validated a clinical prediction rule for penicillin allergy.8 The PEN-FAST (penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment) rule was derived from a prospective cohort of 622 allergy-tested patients in Melbourne, Australia, using a multivariable logistic regression model.

• #70 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/afp/2021/0615/p760.html

  The likelihood of a true allergy in those with a PEN-FAST score of less than 3 points is similar to that for a negative result on skin testing (3.7% vs. 1.9% to 2.9%).3,9,10 Therefore, stratifying patients using the PEN-FAST rule may aid in decisions related to immediate antibiotic treatment and referral for allergy testing.

• #71 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/afp/2021/0615/p760.html

  Penicillin allergy is the most commonly documented drug allergy in medical records, with a prevalence of approximately 10% of all patients.1 However, in up to 90% of patients with a reported allergy, penicillins are tolerated on allergy testing.2 […] A formal drug challenge is the preferred test for investigating immunoglobulin E-mediated penicillin hypersensitivity (type I hypersensitivity)4; skin testing is also a commonly used validated tool.1 […] Despite the high prevalence of patients labeled as having a penicillin allergy, there is an international shortage of those proficient in conducting formal drug challenges.5 […] A more recent study derived and validated a clinical prediction rule for penicillin allergy.8 The PEN-FAST (penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment) rule was derived from a prospective cohort of 622 allergy-tested patients in Melbourne, Australia, using a multivariable logistic regression model.

• #72 Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/challenges-and-opportunities-related-to-penicillin-allergy-in-the-veterans-health-administration-a-narrative-review/F0ED96021ECB279D6F442B49235E19B4

  The VHA Antimicrobial Stewardship Task Force conducted an agency-wide survey on antimicrobial stewardship programs in 2020 that revealed heterogeneity of access to penicillin allergy evaluation services. […] Nationally, there is a shortage of board-certified allergists, a well-recognized problem that is only expected to worsen in the coming years. […] Although there are no published data that report on staffing levels in the VHA, it is known that many VHA facilities of varying sizes and complexity levels do not have allergy/immunology providers on staff. […] Evaluation and clarification of penicillin allergies have also occurred asynchronously without the need for inpatient admission or an outpatient clinic. […] For decades, referral to allergy clinics for PST has been the standard approach for evaluating penicillin allergy both outside and within the VHA. […] Although much is known about the prevalence of penicillin allergy labels within the VHA, there is a relative paucity of data on the impact of such labels on clinical outcomes for veterans admitted to VHA facilities.

• #73 The Penicillin Allergy Conundrum — NUEM Blog

  https://www.nuemblog.com/blog/penicillin-allergy

  Penicillin allergy is the most commonly reported allergy in the United States with a prevalence of up to 12.8% of the population. […] While this may seem inconsequential, recent data suggest patients with reported penicillin allergies have increased hospital length of stay and increased risks of clostridium difficile, vancomycin resistant enterococcus, and MRSA infections. […] We know that of patients who report a penicillin allergy, 90% are able to tolerate penicillin. […] In one prevalence study, only 6% of patients reporting penicillin allergy were referred for allergy testing. […] If the patient is being admitted to the hospital, consider inpatient testing for IgE mediated hypersensitivity as this has been shown to decrease both inpatient complications and cost of care. […] The actual cross-sensitivity between penicillins and cephalosporins is considered much lower than originally proposed when cephalosporins were first marketed in the 1960s.

• #74 Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4210656/

  Despite these reports, there are still few published data on the epidemiology of penicillin allergy in the outpatient population of the United States. […] Our study reveals low numbers of referral to allergy for penicillin reactions. […] Improved documentation of penicillin allergy is called for by all practitioners, and patients should be referred to allergists for well-established and validated methods of penicillin allergy evaluation.

• #75 Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/challenges-and-opportunities-related-to-penicillin-allergy-in-the-veterans-health-administration-a-narrative-review/F0ED96021ECB279D6F442B49235E19B4

  The VHA Antimicrobial Stewardship Task Force conducted an agency-wide survey on antimicrobial stewardship programs in 2020 that revealed heterogeneity of access to penicillin allergy evaluation services. […] Nationally, there is a shortage of board-certified allergists, a well-recognized problem that is only expected to worsen in the coming years. […] Although there are no published data that report on staffing levels in the VHA, it is known that many VHA facilities of varying sizes and complexity levels do not have allergy/immunology providers on staff. […] Evaluation and clarification of penicillin allergies have also occurred asynchronously without the need for inpatient admission or an outpatient clinic. […] For decades, referral to allergy clinics for PST has been the standard approach for evaluating penicillin allergy both outside and within the VHA. […] Although much is known about the prevalence of penicillin allergy labels within the VHA, there is a relative paucity of data on the impact of such labels on clinical outcomes for veterans admitted to VHA facilities.

• #76 The global prevalence of reported penicillin allergy: A systematic review and meta-analysis – EM consulte

  https://www.em-consulte.com/article/1723967/the-global-prevalence-of-reported-penicillin-aller

  We establish that the global prevalence of reported penicillin allergy is 94%. Most data (72%) are derived from three HICs, USA, UK and Australia. HICs had higher prevalence rates than MICs, with no data from LICs. Only 3% of studies focussed solely on primary care. Inter-study variance is influence by methodology, with lower prevalence in studies utilising coded data vs medical records.

• #77 Penicillin Allergy Prevalence Greater in High-Income vs. Middle-Income Nations

  https://www.hcplive.com/view/penicillin-allergy-prevalence-greater-high-income-vs-middle-income-nations

  Investigators wrote the low data on penicillin allergy prevalence in certain continents, such as Africa, Asia, and South America, may suggest penicillin allergy in these places has a lower burden and thus receives less research. […] Countries where English is the primary language had prevalence levels of 10%; no other countries reached this prevalence. […] The study observed that the method of allergy recording significantly impacted the reported prevalence. […] Furthermore, few studies were conducted in primary care (6.5%; 95% CI, 0.2 20.5%) compared with secondary care (10.2%; 9.2% – 11.3%). […] Still, primary care research is underrepresented in the literature.

• #78 De-labelling penicillin allergy in acutely hospitalized patients: a pilot study | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06794-1

  Penicillin allergy de-labeling gave immediate clinical and environmental benefit as the antibiotic treatment regimen could be narrowed from a non-penicillin to a penicillin if the patient suffered from a penicillin-sensitive infection when indicated by the Norwegian national guideline of antibiotic use. […] Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.

• #79 Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/challenges-and-opportunities-related-to-penicillin-allergy-in-the-veterans-health-administration-a-narrative-review/F0ED96021ECB279D6F442B49235E19B4

  The VHA Antimicrobial Stewardship Task Force conducted an agency-wide survey on antimicrobial stewardship programs in 2020 that revealed heterogeneity of access to penicillin allergy evaluation services. […] Nationally, there is a shortage of board-certified allergists, a well-recognized problem that is only expected to worsen in the coming years. […] Although there are no published data that report on staffing levels in the VHA, it is known that many VHA facilities of varying sizes and complexity levels do not have allergy/immunology providers on staff. […] Evaluation and clarification of penicillin allergies have also occurred asynchronously without the need for inpatient admission or an outpatient clinic. […] For decades, referral to allergy clinics for PST has been the standard approach for evaluating penicillin allergy both outside and within the VHA. […] Although much is known about the prevalence of penicillin allergy labels within the VHA, there is a relative paucity of data on the impact of such labels on clinical outcomes for veterans admitted to VHA facilities.

• #80 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  10% of U.S. patients report having a penicillin allergy, but less than 1% of the population is truly allergic. […] However, many patients who report penicillin allergies do not have true IgE-mediated reactions. When evaluated, fewer than 1% of the population are truly allergic to penicillins. […] Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics. […] Broad-spectrum antibiotics are often used as an alternative to penicillins. The use of broad-spectrum antibiotics in patients labeled „penicillin-allergic” is associated with higher healthcare costs, increased risk for antimicrobial resistance, and suboptimal antibiotic therapy. […] Broad-spectrum antibiotics can increase healthcare costs and antimicrobial resistance, and your patient may receive less than the best care. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #81 Practical guide for evaluation and management of beta-lactam allergy: position statement from the Canadian Society of Allergy and Clinical Immunology | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00494-2

  The over-labelling of beta-lactam allergy is associated with increased costs and antimicrobial resistance; testing for beta-lactam allergy would be 9.5 times less expensive than treating an in-patient population with an alternative antimicrobial. […] For these reasons, removal the penicillin allergy label (delabeling) is recommended by multiple organizations, including the American Academy of Allergy, Asthma, and Immunology, the Infectious Disease Society of America, Canadian Pediatric Society, lInstitut National dExcellence en Sant et en Services Sociaux (INESSS) in Quebec, Choosing Wisely Canada, and the Centers for Disease Control and Prevention. […] The label of beta-lactam allergy is common, affecting 10% of the population, and carries with it a risk of negative clinical and socioeconomic outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increased rates of antibiotic-resistant infections, and greater medical costs.

• #82 Penicillin allergy checklist

  https://www.rpharms.com/recognition/all-our-campaigns/antimicrobial-resistance-stewardship/penicillin-checklist

  Hospitalized patients with documented beta-lactam allergies are more likely to experience inferior outcomes, treatment failures, adverse events, and healthcare-associated infections. […] In patients diagnosed with bacterial pneumonia, a penicillin allergy label is associated with an 11% increase in ICU admission and 8% increase in mortality compared to patients without a penicillin allergy label. […] Patients with a penicillin allergy record were six times more likely to be prescribed meropenem than patients without a penicillin allergy record, increasing the selection pressure for the emergence and spread of multiresistant bacteria. […] More healthcare associated infections: alternatives to penicillins tend to be broader-spectrum antibiotics. This both increases the risk of multi-drug resistance developing and causes increased collateral damage to the microbiota of the skin and intestines, associated with higher rates of MRSA carriage and Clostridioides difficile infection in patients with a penicillin allergy label.

• #83 Penicillin allergy: a practical approach to assessment and prescribing – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing.html

  The increased use of broad-spectrum drugs in hospitalised patients with penicillin allergies also contributes to the growing global problem of antimicrobial resistance. […] Antibiotic allergy labels are correlated with increases in length of hospital stay, hospital readmission rates, surgical site infections, and admissions to intensive care units. […] Similarly in general practice, penicillin allergy labels are associated with an increased risk of death and MRSA infection or colonisation. […] It has been demonstrated that more than 90% of patients labelled as having a penicillin allergy would be able to tolerate penicillins following appropriate assessment and allergy testing. […] Even penicillin allergies confirmed by skin tests can wane over time. […] Half the patients who have a positive skin test for penicillins will lose that reactivity after five years.

• #84 The risk of being risk averse: for the majority of patients reporting a penicillin allergy, avoiding penicillin may be doing more harm than good. – The British Society for Antimicrobial Chemotherapy

  https://bsac.org.uk/the-risk-of-being-risk-averse-for-the-majority-of-patients-reporting-a-penicillin-allergy-avoiding-penicillin-may-be-doing-more-harm-than-good/

  The use of broader spectrum antibiotics used in patients with penicillin allergy are associated with many unintended patient and health system outcomes which include: longer length of hospital stays, increased risk of side effects, increased risk of Closteroides difficile-associated diarrhoea, MRSA infection, treatment failure, death, increased antibiotic spend, higher admission rates to critical care, and higher hospital re-admission rates. […] However, more research needs to be conducted in order to explore if removing these incorrect allergy records reverses the associated unintended patient harm and health system consequences associated with use of wider-spectrum antibiotics, while also not risking allergic reactions in these patients.

• #85 Think You Have a Penicillin Allergy? You Might Not.

  https://www.bouldermedicalcenter.com/think-you-have-a-penicillin-allergy-chances-are-you-dont-why-it-matters/

  Correctly identifying those who are not allergic can improve antibiotic prescribing and combat the risk of super-bugs by allowing patients access to safer, less toxic antibiotics. […] According to the CDC, approximately 80 percent of patients with a penicillin allergy lose their sensitivity after 10 years. […] Today, we have skin test methods to help identify patients who may be genuinely penicillin-allergic and those who are not.

• #86 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Correctly identifying those who are not actually allergic can improve antibiotic prescribing and combat the risk of super-bugs by allowing patients access to safer, less toxic antibiotics. […] There is a causal relationship between inappropriate antimicrobial use and resistance; changes in antimicrobial use lead to parallel changes in the prevalence of resistance.

• #87 Penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and antimicrobial resistance (ALABAMA): protocol for a multicentre, parallel-arm, open-label, randomised pragmatic trial | BMJ Open

  https://bmjopen.bmj.com/content/13/9/e072253

  The ALlergy AntiBiotics And Microbial resistance (ALABAMA) trial (full title: penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and AMR) will evaluate participants randomised to either usual care or to receive Penicillin Allergy Assessment Pathway (PAAP). […] This trial aims to address the large discrepancy between reported and true allergy rates and will determine if introducing pre-emptive testing for patients who are more likely to receive antibiotics in the future, could impact on antibiotic prescribing, yield patient benefits, limit AMR/healthcare associated infection and deliver NHS cost savings.

• #88 Study describes global prevalence of reported penicillin allergy | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/study-describes-global-prevalence-reported-penicillin-allergy

  A systematic review and meta-analysis finds that the global prevalence of reported penicillin allergy (PenA) is nearly 10%, though much of the data come from high-income countries (HICs), researchers reported late last week in the Journal of Infection. […] In the 124 full-text, peer-reviewed studies included in the meta-analysis, worldwide prevalence of PenA was 9.4%. Prevalence in HICs (9.9%) was more than twice that of middle-income countries (4.4%). […] „This highlights an unmet need to broaden epidemiological analysis in under-represented regions,” the study authors wrote. […] The findings are noteworthy because research has shown that 95% of people labeled as having PenA are mislabeled and can tolerate penicillins, which are the preferred first-line antibiotics for over 95% of infections, according to the World Health Organization (WHO). […] Given that the WHO has endorsed antibiotic allergy assessment as an important antimicrobial stewardship activity, the authors say more research is needed on penicillin allergy labels in LMICs and LICs.

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