A systematic review and meta-analysis finds that the global prevalence of reported penicillin allergy (PenA) is nearly 10%, though much of the data come from high-income countries (HICs), researchers reported late last week in the Journal of Infection.
Led by researchers from Imperial College London, the review team analyzed 174 studies from 28 countries. Of those studies, 92% were from HICs, with 72% conducted in the United States (95 studies), United Kingdom (18), and Australia (18). In the 124 full-text, peer-reviewed studies included in the meta-analysis, worldwide prevalence of PenA was 9.4%. Prevalence in HICs (9.9%) was more than twice that of middle-income countries (4.4%).
Only one study was published from low- and middle-income countries (LMICs), and none from low-income countries (LICs), with little data from Africa and much of Asia and South America.
"This highlights an unmet need to broaden epidemiological analysis in under-represented regions," the study authors wrote.
The authors also noted that most of the studies were conducted in secondary care settings, with only 16 conducted in primary care.
Many with PenA are mislabeled
The findings are noteworthy because research has shown that 95% of people labeled as having PenA are mislabeled and can tolerate penicillins, which are the preferred first-line antibiotics for over 95% of infections, according to the World Health Organization (WHO). Patients with PenA often receive broader-spectrum antibiotics that can promote antimicrobial resistance and are associated with increased risk of adverse events.
Given that the WHO has endorsed antibiotic allergy assessment as an important antimicrobial stewardship activity, the authors say more research is needed on penicillin allergy labels in LMICs and LICs.