Working to identify mislabeled penicillin allergies

Published: 24 July 2023

About one in 10 people are reported to have a penicillin allergy. Those patients are more likely to be prescribed alternative antibiotics that are often less effective against certain infections. This can lead to treatment failure, increased risks of antibiotic resistance and the development of superbugs. Yet, fewer than five per cent of patients labelled with a penicillin allergy are truly allergic. 

A recent study by a team of researchers from six specialized centres in Canada, the U.S. and Australia sought to address these issues by evaluating a new approach to identifying patients at low risk of penicillin allergy and determining the best way to test and treat them. The results of this clinical trial, published in JAMA Internal Medicine, pave the way for the adoption of a simple oral test called “direct oral penicillin challenge” as a safe and effective alternative to traditional skin testing, which is labour-intensive, not easily accessible to all, as well as time-consuming and painful for the patients.  

“The biggest takeaway from the PALACE study is that patients with a low-risk penicillin allergy, like a childhood rash, can safely have a test dose of penicillin to determine if they are still allergic. This will change the way doctors test for penicillin allergy in the future. Millions of patients worldwide, including millions of Canadians, will be able to have their penicillin allergy disproved by a safe single oral test dose following a carefully risk-validated risk assessment,” says Dr. Ana-Maria Copaescu, first author of the study, associate investigator in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre (RI-MUHC), who was the leading investigator for the North American sites.    

The article Efficacy of a clinical decision rule to enable direct oral challenge in a patients with low-risk penicillin allergy – The PALACE Randomized clinical Trial by Ana-Maria Copaescu et al., was published in JAMA Internal Medicine. 

Back to top