The documented penicillin allergy is often incorrect. Targeted de-labeling improves antibiotic therapy, reduces side effects and lowers the development of resistance. New strategies such as PEN-FAST and oral provocation tests facilitate the reliable exclusion of a penicillin allergy.

The challenge of a penicillin allergy

Penicillins are among the most effective and well-tolerated antibiotics. Nevertheless, a penicillin allergy is documented in the medical records of around 10% of the population. However, studies show that an average of 10% of those affected are actually allergic. This is usually because the reported symptoms are not due to an allergy but to an intolerance and an allergy does not last a lifetime. Approximately 80% of allergic IgE-mediated reactions disappear after 10 years. These misdiagnoses mean that patients often receive less effective second-line antibiotics, which promotes the development of resistance and increases morbidity and treatment costs.

The concept of delabeling

De-labeling describes the removal of a penicillin allergy label (PAL) after an allergy has been reliably ruled out. This is a key antibiotic stewardship measure. Studies have shown that many misdiagnoses can be quickly and safely revised through targeted anamnesis and risk-adapted test strategies, such as PEN-FAST or direct oral provocation tests (DOP).

Clinical decision tools: PEN-FAST and DOP

With the PEN-FAST clinical algorithm, the allergy risk is precisely assessed based on factors such as the type and time of previous reactions. Patients with a very low risk (0 points) can often be de-labeled directly. If the risk is low, a DOP enables an allergy to be ruled out with certainty. In studies, only 3.4% of the people tested showed an allergic reaction – no serious complications occurred.

The current situation in Germany

Despite international findings, there is a lack of established routines for de-labeling using medical history in Germany. An expansion of day clinic services for the implementation of DOP could also close this gap and lead to more effective antibiotic therapy. However, monitoring by qualified personnel remains crucial.

Conclusion

The de-labeling of penicillin allergies is a practical, safe and effective method for improving the quality of treatment. Innovative tools such as PEN-FAST and DOP could significantly increase patient safety and therapeutic success.

The Limbach Group supports you in all matters relating to de-labeling and modern antibiotic stewardship measures. Please do not hesitate to contact us for further information. Please contact us: infektiologie@limbachgruppe.com

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