About Allergy De-Labelling

Allergy de-labelling is the process for removing an allergy from a person’s list of allergies. This can be a very important process in some situations.

An example is penicillin allergy. Many people experience mild adverse reactions after taking penicillin, but most of these are minor and are not allergic reactions. They are usually not dangerous.

Having a label of penicillin allergy can lead to health professionals avoiding some entire families of antibiotics inappropriately. 

In surgery, avoidance of penicillin drugs has been shown to lead to increased rates of surgical site infections, which can be devastating. Use of second-line antibiotics has also been linked to increased risk of re-admission to hospital, increased length-of-stay, and an increased need for admission to intensive care.

A penicillin allergy test used to be a complex process. Penicillin allergy testing previously involved having a consultation, then returning for a penicillin allergy test using skin pricks or skin injections, and then often a further appointment for an oral drug challenge to complete the process. Our more modern process for penicillin allergy de labelling is called “direct” Penicillin delabeling or “direct” oral challenge, and is able to bypass the skin prick or skin test component in most cases.

Direct penicillin de-labelling involves looking carefully at the history of the reaction, asking appropriate questions, and then performing an oral drug challenge to a penicillin drug to prove that the person is not allergic. Skin pricks or injections are not performed. If the history suggests a high risk of the penicillin allergy being real, then drug challenge is not performed, but the patient would be suitable for “traditional” skin testing at a later time. This process of direct Penicillin allergy de labelling can be done in a single appointment of around 75 minutes, most of which is observation time. The vast majority of penicillin allergic patients can be de-labelled in this way.

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