A RECENT study has demonstrated that anaesthesiologist-led preoperative clinics can successfully delabel low-risk penicillin and cephalosporin allergies using a smartphone application with a decision support algorithm. This pilot randomised clinical trial, conducted across three tertiary hospitals in Melbourne, Australia, involved 150 adult patients who had reported a β-lactam antibiotic allergy and were likely to require intravenous antibiotic prophylaxis for surgery. The findings suggest that the intervention is both feasible and safe, with a high success rate in allergy delabelling.
The trial, carried out between December 2020 and October 2023, assessed the feasibility and safety of integrating enhanced allergy assessment within preoperative anaesthesia clinics, thereby expanding allergy delabelling beyond specialist allergy services. Patients were randomised into intervention and control groups on a 1:1 basis. The intervention group underwent an enhanced allergy evaluation using a smartphone application, which utilised a validated decision support algorithm. The tool provided risk scores to determine the appropriate allergy testing method, categorising patients as either low or moderate/high risk.
Among the 74 patients assigned to the intervention, 47 underwent allergy testing. Of these, 28 were classified as low risk, and 93% were successfully delabelled following direct oral challenge. In the moderate-to-high risk group, 19 of 44 patients proceeded with further testing. The primary safety outcome measured adverse antibiotic-related events within 90 days post-surgery. Only four patients in the intervention group (5.4%) reported an adverse event, with one case of a benign rash considered immune-mediated. Crucially, no severe reactions were observed, and no surgical delays resulted from the intervention.
The study also highlighted a reduction in restricted antibiotic use among patients in the intervention group (10.7%) compared with the control group (17.9%). This suggests that preoperative allergy delabelling may lead to more appropriate antibiotic prescribing, improving infection-related outcomes and perioperative care.
These findings provide strong evidence that anaesthesiologist-led allergy delabelling using digital decision support is a viable approach in preoperative assessment. The study reinforces the safety of integrating such an intervention into routine surgical preparation, paving the way for broader implementation to enhance antibiotic stewardship and patient care.
Katie Wright, EMJ
Reference
De Luca JF et al. Perioperative penicillin and cephalosporin antibiotic allergy assessment and testing: the PREPARE pilot randomized clinical trial. JAMA Surg. Published online March 26, 2025. doi:10.1001/jamasurg.2025.0279.
