Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review

Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 21 May 2025 V1 Latest version Share on Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review Authors : Jessie He , Marina Guirguis , Sankare Devanandan , Rani Scott-Farmer , Sandra Vale , Michaela Lucas , Jennifer Koplin J , Catherine J. Hornung , and Sandra Salter 0000-0002-5840-6797 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174783447.73413776/v1 Published Clinical & Experimental Allergy Version of record Peer review timeline 289 views 150 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Penicillin allergy delabelling (PADL) is increasingly recognised as a key antimicrobial stewardship strategy and important public health priority. Over the past decade, multiple PADL guidelines (PADLGs) have been published, yet the consistency of their recommendations and overall quality have not been systematically reviewed. This review compared the scope, purpose, and recommendations of internationally published PADLGs, and assessed their quality using the Appraisal of Guidelines for Research and Evaluation II instrument. Eighteen guidelines published between 2014 and 2024 were identified, representing twelve countries across four regions. Most guidelines provided recommendations for risk stratification, testing, and delabelling methods, with many supporting direct delabelling/direct challenge in low-risk patients. However, substantial variation was observed in risk assessment tools, eligibility criteria, and post-test delabelling strategies, highlighting opportunities for greater standardisation. Overall, the quality of PADLGs was low, with only two meeting predefined high-quality criteria. Critical gaps included limited methodological rigour, poor stakeholder involvement, and lack of guidance for real-world implementation. PADLGs also demonstrated variation in scope, target users, and clinical recommendations, both within and across clinical settings. To support safe and scalable PADL approaches, clearer, more consistent, and methodologically robust guidelines are needed to address the global burden of inappropriate penicillin allergy labels. Supplementary Material File (figure 1.pptx) Download 53.20 KB File (main file - quality and consistency of penicillin allergy delabelling guidelines - a systematic review 2025-05-19.docx) Download 130.21 KB Information & Authors Information Version history V1 Version 1 21 May 2025 Peer review timeline Published Clinical & Experimental Allergy Version of Record 6 Mar 2026 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords allergy diagnosis challenge tests drug allergy regulatory aspects Authors Affiliations Jessie He The University of Western Australia School of Allied Health View all articles by this author Marina Guirguis The University of Western Australia School of Allied Health View all articles by this author Sankare Devanandan The University of Western Australia School of Allied Health View all articles by this author Rani Scott-Farmer National Allergy Centre of Excellence (NACE View all articles by this author Sandra Vale National Allergy Council View all articles by this author Michaela Lucas National Allergy Centre of Excellence (NACE View all articles by this author Jennifer Koplin J National Allergy Centre of Excellence (NACE View all articles by this author Catherine J. Hornung National Allergy Centre of Excellence (NACE View all articles by this author Sandra Salter 0000-0002-5840-6797 [email protected] The University of Western Australia School of Allied Health View all articles by this author Metrics & Citations Metrics Article Usage 289 views 150 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Jessie He, Marina Guirguis, Sankare Devanandan, et al. Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review. Authorea . 21 May 2025. DOI: https://doi.org/10.22541/au.174783447.73413776/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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