The Australasian Society of Clinical Immunology and Allergy has issued new guidance for adult penicillin-allergy records, giving clinicians risk-based ways to review labels that may limit treatment choices. ASCIA says evaluation can show that penicillin is tolerated by more than 90% of people whose records list an allergy.
ASCIA estimates about one in 10 people report a penicillin allergy, while fewer than 1% of the population are thought to be truly allergic. It estimates about 2.8 million Australians may report an allergy. The updated guidance replaces the society’s 2020 consensus statement, developed with a multidisciplinary panel of 27 drug-allergy experts through a Delphi consensus process.
The guidance sorts adults into minimal, low, intermediate and high-risk groups. Clinicians may consider removing the label without more testing for patients ASCIA classifies as minimal risk. A simple rash from at least five years earlier may place an adult in the low-risk group, where an oral challenge may be considered, including in community practice. ASCIA advises specialist referral for intermediate- and high-risk patients. Any challenge should be led by trained health professionals prepared to treat anaphylaxis.
The National Allergy Council says an allergy record may begin with a rash during a childhood illness, a medication side effect or a family member’s history. The council says people with inaccurate labels may have fewer treatment options, while health services may face longer stays and readmissions. It also warns that unnecessary use of alternative antibiotics can contribute to antimicrobial resistance.
A 2023 review of 32 studies covering more than 1 million participants found that reported antibiotic allergies, considered broadly and not just penicillin allergies, were associated with greater use of alternatives and poorer adherence to prescribing guidance in 30% to 60% of cases.
Professor Michaela Lucas, a clinical immunology and allergy specialist and co-chair of the National Allergy Council’s Drug Allergy Working Group, said people could ask their doctor whether a proper investigation may be appropriate for them. ASCIA says it plans to update its pediatric guidance in early 2027.
