Validation of the first risk stratification based penicillin delabeling
program outside an allergy clinic in Norway
Abstract
Background: Penicillin allergy is self-reported by 3-10% of
patients admitted to hospital. The label is wrong in 90% of the cases
and has severe health implications. Penicillin-delabeling can reverse
the negative effects of the label, and pathways adapted to local
practice are needed. No tools are available in Norway for penicillin
delabeling outside an allergy clinic. Methods: An
interdisciplinary taskforce created a penicillin allergy delabeling
program (PAD) adapted to the Norwegian health care system. This was
validated in a prospective, single-centre study. Very low-risk and
low-risk patients underwent a direct oral penicillin challenge and
high-risk patients were referred for allergologic evaluation.
Results: 149 patients declaring penicillin allergy were
included. Seventy-four (50%) were very-low- and low risk patients
suitable for a direct oral penicillin challenge resulting in only one
mild reaction. 60 high-risk patients were eligible for an oral
penicillin challenge after allergologic evaluation, three patients
reacted non-severely. Conclusion: We have demonstrated
excellent repeatability and feasibility of the first PAD applicable in a
hospital setting outside an allergy clinic in Norway. Our data suggests
this is safe and beneficial, with 49% patients delabeled through a
direct oral penicillin challenge, performed without any serious adverse
events, and an overall 87% delabeling rate.