The democratisation of de-labelling: a review of direct oral challenge in adults with low-risk penicillin allergy.

Abstract

Penicillin antibiotic allergy labels (AALs) are common and lead to significant negative health and health system outcomes. Direct oral challenge offers a rapid and cost-effective way of removing inaccurate AALs and improving outcomes. A narrative review (Medline, May 2020) of direct oral challenge in low-risk penicillin allergy in adults is described and the evidence for the safety and efficacy of this approach in inpatients, outpatients and special patient groups is presented. Whilst the current literature demonstrates the safety and efficacy of direct oral challenge in de-labelling low-risk penicillin allergy in adults, novel approaches are needed to improve access to antibiotic allergy assessment and address the growing global need.