Prospective, Multicenter, Head-to-Head Comparison Between Allergists Versus Nonallergists in Low-Risk Penicillin Allergy Delabeling: Effectiveness, Safety, and Quality of Life (HK-DADI2)

Jane C Y Wong; Andy K C Kan; Thomas S H Chik; M Y Chu; Timothy C M Li; Hugo W F Mak; Valerie Chiang; Philip H Li

doi:10.1016/j.jaip.2024.04.010

Prospective, Multicenter, Head-to-Head Comparison Between Allergists Versus Nonallergists in Low-Risk Penicillin Allergy Delabeling: Effectiveness, Safety, and Quality of Life (HK-DADI2)

J Allergy Clin Immunol Pract. 2024 Apr 16:S2213-2198(24)00394-5. doi: 10.1016/j.jaip.2024.04.010. Online ahead of print.

Authors

Jane C Y Wong¹, Andy K C Kan¹, Thomas S H Chik², M Y Chu³, Timothy C M Li⁴, Hugo W F Mak¹, Valerie Chiang⁵, Philip H Li⁶

Affiliations

¹ Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
² Division of Infectious Diseases, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong.
³ Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
⁴ Division of Infectious Diseases, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong.
⁵ Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.
⁶ Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Electronic address: liphilip@hku.hk.

PMID: 38631522
DOI: 10.1016/j.jaip.2024.04.010

Abstract

Background: Penicillin "allergy" labels are prevalent but frequently misdiagnosed. Mislabelled allergies are associated with adverse outcomes and increased antimicrobial resistance. With an urgent need to delabel the overwhelming number of mislabeled allergies, nonallergist evaluations have been advocated for low-risk individuals. Despite growing interest in non-allergist-led initiatives, evidence on their effectiveness, safety, and impact by direct comparisons is lacking.

Objective: To assess the comparative outcomes of penicillin allergy evaluations conducted by allergists versus nonallergists.

Methods: A prospective, multicenter, pragmatic study was conducted at 4 tertiary hospitals (1 allergist- vs 3 non-allergist-led) for low-risk penicillin allergy patients in Hong Kong-the Hong Kong Drug Allergy Delabelling Initiative 2 (HK-DADI2).

Results: Among 228 low-risk patients who underwent testing (32.9% by allergists, 67.1% by nonallergists), only 14 (6.1%) had positive penicillin allergy testing results. Delabeling rates (94.1% vs 93.3%; P = .777), positive skin test results (2.6% vs 2.7%; P > .99), and drug provocation test results (3.3% vs 2.7%; P = 1.000) were similar between allergists and nonallergists. There were no systemic reactions in either cohort. All patients had significant improvements in health-related quality of life (Drug Hypersensitivity Quality of Life Questionnaire scores -5.00 vs -8.33; P = .072). Nonallergist evaluations had shorter waiting times (0.57 vs 15.7 months; P < .001), whereas allergists required fewer consultations with higher rate of completing evaluations within a single visit (odds ratio, 0.04; P < .001).

Conclusions: With training and support, nonallergists can independently evaluate low-risk penicillin allergies. Compared with allergists, evaluation of low-risk penicillin allergy by nonallergists can be comparably effective, safe, and impactful on quality of life. More multidisciplinary partnerships to empower nonallergists to conduct allergy evaluations should be encouraged.

Keywords: Allergist; Allergy; Delabeling; Drug; Effectiveness; Multidisciplinary; Nonallergist; Penicillin; Quality of life; Safety.