More than 95% of patients with low-risk penicillin allergy do not react to direct oral challenge, an Australian-led study has found.

The researchers offered direct oral challenge (DOC) to 1573 patients in eight countries — including almost 1400 Australians — who were identified as low risk following an allergy assessment.

Only 71 had a positive result, of whom only six had a serious adverse event, all of which were treatable with corticosteroids, antihistamines, antiemetics or salbutamol, with no anaphylaxis or ICU admissions.

“This study provides the largest single experience of inpatient penicillin DOC with real-world, pragmatic implementation of local hospital–directed DOC procedures and guidelines,” the researchers wrote in Clinical Infectious Diseases this month.