Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head…

StudyAllergy, asthma & immunology research· Jul 2026

Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.

Freya Kl Chung, Weihong Shi, Man Yui Chong … Philip H Li

Allergy & ImmunologyStudyClinical practiceQ2IF 3.6

Non-allergist risk-stratification tools show high sensitivity for detecting true penicillin allergy

Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.

Freya Kl Chung … Philip H Li

Allergy, asthma & immunology research · Jul 2026 · Q2 in Immunology & Allergy

Background

Asia Pacific Association of Allergy, Asthma, and Clinical Immunology (APAAACI) and PENFAST risk-stratification tools can facilitate non-allergist delabeling, but their comparative real-world performance remains unknown.

Purpose

The purpose of this study was to prospectively evaluate APAAACI and PENFAST against allergist assessment and drug provocation testing (drug provocation testing) outcomes.

Methods

We assessed diagnostic performance (area under the curve [AUC]-receiver operating characteristic, accuracy, sensitivity, specificity, positive and negative predictive values [NPVs]) and agreement (Cohen's κ) of these tools.

n = 103 adults

Results

correctly flagged nearly all true allergies, missing few real cases

AUC 0.82 (95% CI 0.69 to 0.95)

null 0

0.69

0.95

CI excludes the null - significant

More results

Overall, allergist assessment demonstrated the highest AUC of 0.82 (95% confidence interval [CI], 0.69-0.95), outperforming APAAACI (AUC, 0.79; 95% CI, 0.66-0.92; P = 0.012) and PENFAST (AUC, 0.75; 95% CI, 0.62-0.89; P = 0.010).

APAAACI showed excellent agreement with allergist assessment (κ = 0.96, P < 0.001) versus moderate agreement for PENFAST (κ = 0.43).

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Conclusion · 1 of 2

APAAACI and PENFAST can both effectively identify low-risk patients labelled with penicillin allergy when used by non-allergists, with comparable sensitivity to allergist assessment.

Conclusion · 2 of 2

APAAACI's stronger agreement with allergist assessment may suggest particular utility in Asian populations. These tools can significantly improve access to delabeling in settings lacking specialist allergy services.

Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.

Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.

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