Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

L. C. Savic, D. A. Khan, P. Kopac, R. C. Clarke, P. J. Cooke, P. Dewachter, D. G. Ebo, T. Garcez, L. H. Garvey, A. B. Guttormsen, P. M. Hopkins, D. L. Hepner, H. Kolawole, M. Krøigaard, J. J. Laguna, S. D. Marshall, P. M. Mertes, P. R. Platt, M. A. Rose, V. SabatoP. H.M. Sadleir, S. Savic, T. Takazawa, S. Voltolini, G. W. Volcheck

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

Original languageEnglish (US)
Pages (from-to)e82-e94
JournalBritish Journal of Anaesthesia
Issue number1
StatePublished - Jul 2019


  • allergy
  • drug provocation testing
  • penicillin
  • prophylaxis
  • surgery
  • surgical site infection

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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