Moitra Saibal, Liyanage Guwani, Tonkin-Crine Sarah, Powell Neil, Jani Yogini, Dasanayake Dhanushka, Badanasinghe Nadisha, Haque Mohammad Ziaul, Kudagammana Wasana, Kumar Raj, Mahesh Padukudru Anand, Thong Bernard Yu-Hor, Meng Juan, Christopher Devasahayam Jesudas, Krishna Mamidipudi Thirumala
Division of Allergy and Immunology, Department of Respiratory Medicine, Apollo Multispecialty Hospitals, Kolkata, India.
Department of Paediatrics, University of Jayewardenepura, Nugegoda, Sri Lanka.
Clin Exp Allergy. 2025 May;55(5):367-377. doi: 10.1111/cea.14624. Epub 2025 Jan 23.
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.
来自印度和斯里兰卡的关于青霉素过敏标签（PALs）的数据稀少。新出现的数据表明，在印度和斯里兰卡的二级医疗保健机构中，声明未经证实的青霉素过敏的患者比例（1%-4%）低于高收入国家报告的比例（15%-20%）。然而，即使是这个相对较小的百分比，换算成绝对数字也很大，因为这部分地区约占全球人口的25%。印度和斯里兰卡对过敏专科医生有巨大的需求缺口。青霉素过敏管理因皮肤试验试剂难以获得、缺乏药物过敏方面的正规培训、未经培训的操作人员进行的先发制、不规范和无监管的皮肤试验以及薄弱的卫生服务框架而进一步受到影响。这对抗菌药物管理产生了不利影响，特别是在风湿热、风湿性心脏病、细菌性心内膜炎、梅毒和其他性传播感染的管理方面。这篇叙述性综述强调了印度和斯里兰卡青霉素过敏标签的负担以及已发表文献中的差距。它描述了当前的挑战以及一种务实、谨慎且分阶段的定制缓解方法，以根据世界卫生组织的AWaRe指南改进和规范抗菌药物管理。
