Update from Maryam Sherkat Masoum Antimicrobial Stewardship Pharmacist, Royal Perth Bentley Group.
Around nine per cent of hospitalised patients in Australia report a penicillin allergy, yet fewer than one per cent have a true immune-mediated allergy1. Inaccurate allergy labels limit optimal antibiotic choice, increase health care costs and contribute to antimicrobial resistance. To address this, many WA hospitals have introduced inpatient antibiotic allergy assessment and de-labelling (AADL) services. These services are currently focused on adult patients and primarily target penicillin allergies, although other antibiotics may also be assessed.
During hospital admission, patients with a penicillin allergy label may undergo:
- Direct de-labelling: When the reported reaction was a predictable side effect (e.g. nausea, headache) rather than a true allergy, or when there has been confirmed tolerance of penicillin since the index reaction.
- Oral challenge: A supervised single-dose oral penicillin, used in low-risk patients (e.g. benign rash in childhood, unclear reaction more than 10 years ago). Around 96 per cent of such patients tolerate penicillin without issue2. Patients are reviewed and followed up to ensure no delayed reactions.
- Referral to immunology services: For patients with severe or high-risk reaction histories.
Hospital clinicians will write to GPs when an allergy label has been reviewed and safely removed, requesting that practice records and the patient’s My Health Record be updated.
Patients are generally asked to make an appointment with their GP to support this process .
Step three in the My Health Record Event Summaries Guide for Clinical Immunology and Allergy Specialists (Australasian Society of Clinical Immunology and Allergy / National Allergy Council), demonstrates the recommended standardised approach for documenting allergy de-labelling, including the use of the wording “confirmed NOT ALLERGIC” in the substance/agent field, together with details of the challenge date and specialist in the reaction/manifestation field. Refer to the screenshot, left.