Penicillin allergy management in India and Sri Lanka: current challenges
Moitra, Saibal Liyanage, Guwani Tonkin-Crine, Sarah Powell, Neil Jani, Yogini Dasanayake, Dhanushka Badanasinghe, Nadisha Haque, Mohammad Ziaul Kudagammana, Wasana Kumar, Raj
Moitra, Saibal
Liyanage, Guwani
Tonkin-Crine, Sarah
Powell, Neil
Jani, Yogini
Dasanayake, Dhanushka
Badanasinghe, Nadisha
Haque, Mohammad Ziaul
Kudagammana, Wasana
Kumar, Raj
Affiliation
Apollo Multispecialty Hospitals; University of Jayewardenepura; Sri Lanka College of Paediatricians; University of Oxford; Royal Cornwall Hospitals NHS Trust; University College London Hospitals NHS Foundation Trust; University of London; Allergy and Immunology Society of Sri Lanka; Medical Research Institute; Sri Lanka College of Microbiologists; University of Peradeniya; V P Chest Institute; Indian College of Allergy, Asthma and Applied Immunology; JSS Medical College; Tan Tock Seng Hospital; Sichuan University; West China Hospital; Christian Medical College; Indian Chest Society; University of Birmingham; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2025-01-23
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Abstract
Data regarding Penicillin allergy labels (PALs) from India and Sri Lanka are sparse. Emerging data suggests that the proportion of patients declaring an unverified PAL in secondary care in India and Sri Lanka (1%-4%) is lesser than that reported in High Income Countries (15%-20%). However, even this relatively small percentage translates into a large absolute number, as this part of the world accounts for approximately 25% of the global population. There is a huge unmet need for allergy specialists in India and Sri Lanka. Penicillin allergy management is further compromised by unavailability of skin test reagents, lack of formal training in drug allergy, pre-emptive, non-standardised and unregulated skin testing by untrained operators and a weak health service framework. This has an adverse impact on antimicrobial stewardship, particularly in the management of rheumatic fever, rheumatic heart disease, bacterial endocarditis, syphilis and other sexually transmitted infections. This narrative review highlights the burden of PALs in India and Sri Lanka, as well as gaps in the published literature. It describes current challenges and a pragmatic, cautious and staged bespoke mitigation approach to improve and standardise antimicrobial stewardship in accordance with the World Health Organisation AWaRe guidance.
Citation
Moitra S, Liyanage G, Tonkin-Crine S, Powell N, Jani Y, Dasanayake D, Badanasinghe N, Haque MZ, Kudagammana W, Kumar R, Mahesh PA, Thong BY, Meng J, Christopher DJ, Krishna MT. Penicillin Allergy Management in India and Sri Lanka: Current Challenges. Clin Exp Allergy. 2025 May;55(5):367-377. doi: 10.1111/cea.14624. Epub 2025 Jan 23.
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Article