Science to Practice
Latest highlights on drug safety and efficacy

28.4.2025

According to recent research, over 95% of people labeled as allergic to penicillin are not truly allergic. Nevertheless, millions of patients continue to avoid β-lactam antibiotics, leading to the use of less effective alternatives, increased antibiotic resistance, and higher healthcare costs (1).

In the United States, 10–15% of hospitalised patients carry a penicillin allergy label, whereas in parts of Europe the figure is below 3%. However, true IgE-mediated allergy is confirmed in only 1–2% of cases. Direct drug provocation testing (DPT) has proven to be a safe, fast, and cost-effective method for removing incorrect allergy labels, especially in low-risk patients (1).

Over 95% of penicillin allergy labels are incorrect – yet millions still avoid effective treatments. Safe and simple testing can restore access to first-line antibiotics, reduce resistance, and lower healthcare costs.

Meta-analyses show that over 94% of patients tolerate penicillin after testing, with adverse reactions —mostly mild – occurring in less than 2% of cases. Non-allergist physicians and healthcare professionals are increasingly involved in delabeling, supported by validated tools and guidelines (1).

Despite promising results, fewer than 40% of eligible patients undergo delabeling. Integrating delabeling into antibiotic stewardship and treatment protocols is particularly important in countries with limited access to allergists (1). In addition, a verified penicillin allergy should be documented at the individual drug level (e.g. amoxicillin), as cross-reactivity varies between different penicillins and other beta-lactam antibiotics (2,3).

Healthcare systems should develop scalable and efficient strategies to address this widespread issue.

For more comprehensive insights, explore Xreactbase, our specialised database designed to identify potential drug cross-hypersensitivities.

News produced by Medbase Medical Team

References

1. Tejedor-Alonso MA, Perez-Encinas M, Sanz Márquez S, Martinez Simon JJ, Moreno-Nuñez L, Gonzalez-Moreno A, Macias-Iglesias J, Rosado-Ingelmo A. How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem. J Investig Allergol Clin Immunol. 2025 Feb 18;35(1):12-23. https://pubmed.ncbi.nlm.nih.gov/38725322/
2. Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet JC, Celik G, Cernadas J, Chiriac AM, Demoly P, Garvey LH, Mayorga C, Nakonechna A, Whitaker P, Torres MJ. Towards a more precise diagnosis of hypersensitivity to beta-lactams – an EAACI position paper. Allergy. 2020 Jun;75(6):1300-1315.
3. Hutten EM, Bulatović Ćalasan M, Trubiano JA, Pleijhuis RG, Terreehorst I. Discrepancies in Beta-Lactam Antibiotics Cross-Reactivity: Implications for Clinical Practice. Allergy. 2025 Feb 21;