Background: Penicillin allergy is self-reported by 3-10% of patients admitted to hospital. The label is wrong in 90% of the cases and has severe health implications. Penicillin-delabeling can reverse the negative effects of the label, and pathways adapted to local practice are needed. No tools are available in Norway for penicillin delabeling outside an allergy clinic. Methods: An interdisciplinary taskforce created a penicillin allergy delabeling program (PAD) adapted to the Norwegian health care system. This was validated in a prospective, single-centre study. Very low-risk and low-risk patients underwent a direct oral penicillin challenge and high-risk patients were referred for allergologic evaluation. Results: 149 patients declaring penicillin allergy were included. Seventy-four (50%) were very-low- and low risk patients suitable for a direct oral penicillin challenge resulting in only one mild reaction. 60 high-risk patients were eligible for an oral penicillin challenge after allergologic evaluation, three patients reacted non-severely. Conclusion: We have demonstrated excellent repeatability and feasibility of the first PAD applicable in a hospital setting outside an allergy clinic in Norway. Our data suggests this is safe and beneficial, with 49% patients delabeled through a direct oral penicillin challenge, performed without any serious adverse events, and an overall 87% delabeling rate.

In the newly published article: “Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity” K. Brockow [1], suggested an algorithm for the evaluation of hypersensitivity to radiocontrast media (RCM). However, one important aspect has been left out of the suggested algorithm, the opportunity to desensitize patients with probable or confirmed immediate hypersensitivity reactions to radiocontrast media.  Especially those reacting to more than one substance. Desensitization to allergens is a standard preventative measure of anaphylaxis when patients have a history of severe immediate hypersensitivity reactions to a drug, and there are no therapeutic alternatives [2]. Protocols for RCM desensitization are known from case reports [3,4], and need more work and research before standardized protocols can be recommended, but they can facilitate the use of radiocontrast media in important situations such as the need for acute coronary angiograms. Such situations are rare, but an algorithm should include information and pathways to facilitate the best treatment possible for all patients. Suggested change in the algorithm is to include the option “rapid desensitization” in the pathway “RCM urgently needed without test possibility and indispensable need for the RCM”, and in the pathway for ”patients with confirmed RCM hypersensitivity with immediate hypersensitivity reactions to several RCM’s for situations with indispensable need for RCM”. This would help to facilitate the best point of care for more patients with hypersensitivity to RCM. Dr. Alnæs has nothing to disclose. Dr Alnæs is the only contributor to this article.  1.     Knut Brockow, Medical algorithm: Diagnosis and treatment of radiocontrast media hypersensitivity Allergy 2020 ;75:1278-1280. doi: 10.1111/all.14147. 2.     P. Demoly  N. F. Adkinson  K. Brockow et al. International Consensus on drug allergy, Allergy 2014; 69: 420-437.  https://doi.org/10.1111/all.123503.     Mona Al-Ahmada and Tito Rodriguez Bouzab ,Successful desensitization to radiocontrast media in two high-risk cardiac patients. Ann Saudi Med. 2017; 37(4): 333–335. doi: 10.5144/0256-4947.2017.333 4.     Saurav Uppal , Anthony E DeCicco , Anselma Intini  et al. Rapid Desensitization to Overcome Contrast Allergy Prior to Urgent Coronary Angiography. Int Heart J  2018; 30; 59(3):622-625. doi: 10.1536/ihj.17-395.