Shi Weihong, Liu Ning, Huang Jin-Xian, Xiao Hao, Meng Juan, Li Philip H
Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
Clin Exp Allergy. 2025 Aug;55(8):625-633. doi: 10.1111/cea.14546. Epub 2024 Jul 25.
Penicillins are the most frequently prescribed class of medications worldwide and first-line antibiotic of choice for most bacterial infections. They are also commonly labelled as the culprit of drug 'allergy'; leading to obligatory use of second-line antibiotics, suboptimal antibiotic therapy and increased antimicrobial resistance. However, the majority of reported penicillin 'allergy' labels are found to be incorrect after allergy testing, emphasising the importance of proper drug allergy testing and evaluation. Penicillin skin testing (PST) remains an important component of drug allergy diagnosis; however, its practice and policies significantly differ across the world. Inappropriate and non-evidence-based PST practices can lead to consequences associated with allergy mislabelling. Even within different regions of China, with a population exceeding 1.4 billion, there are marked differences in the implementation, execution and interpretation of PST. This review aims to examine the differences in PST between Mainland China, Hong Kong and the rest of the world. We critically analyse the current practice of 'pre-emptive' PST in Mainland China, which has a significant false-positive rate leading to high levels of penicillin allergy mislabelling. Non-evidence-based practices further compound the high false-positive rates of indiscriminatory PST. We postulate that inappropriate PST policies and practices may exacerbate the mislabelling of penicillin allergy, leading to unnecessary overuse of inappropriate second-line antibiotics, increasing antimicrobial resistance and healthcare costs. We advocate for the importance of more collaborative research to improve the contemporary workflow of penicillin allergy diagnosis, reduce mislabelling and promote the dissemination of evidence-based methods for allergy diagnosis.
青霉素是全球最常被处方的一类药物，也是大多数细菌感染的一线首选抗生素。它们也常被视为药物“过敏”的罪魁祸首，导致必须使用二线抗生素，使抗生素治疗效果欠佳，并增加了抗菌药物耐药性。然而，经过敏测试后发现，大多数报告的青霉素“过敏”标签是不正确的，这凸显了进行正确的药物过敏测试和评估的重要性。青霉素皮肤试验（PST）仍然是药物过敏诊断的重要组成部分；然而，其操作方法和政策在世界各地存在显著差异。不恰当且缺乏循证依据的PST操作可能会导致与过敏错误标注相关的后果。即使在中国人口超过14亿的不同地区，PST的实施、执行和解读也存在明显差异。本综述旨在探讨中国大陆、香港与世界其他地区在PST方面的差异。我们批判性地分析了中国大陆目前“预防性”PST的做法，其假阳性率很高，导致青霉素过敏错误标注的比例很高。缺乏循证依据的做法进一步加剧了不加区分的PST的高假阳性率。我们推测，不恰当的PST政策和做法可能会加剧青霉素过敏的错误标注，导致不必要地过度使用不恰当的二线抗生素，增加抗菌药物耐药性和医疗成本。我们主张开展更多合作研究的重要性，以改进青霉素过敏诊断的现代工作流程，减少错误标注，并推广基于证据的过敏诊断方法。
