New penicillin allergy guidance aims to support GPs
23 Oct 2026
Many Australians who believe they are allergic to penicillin may not have a confirmed allergy. New guidance from the Australasian Society of Clinical Immunology and Allergy (ASCIA) aims to help GPs assess these patients and decide whether further testing is needed.
About 10% of Australians, or around 2.8 million people, report a penicillin allergy. However, up to 90% of people with a recorded penicillin allergy are found not to be allergic after proper assessment.
The National Allergy Council says reported antibiotic allergies can lead to longer treatment and hospital stays, more hospital readmissions and greater use of alternative antibiotics.
Penicillin sensitivity can also change over time. Around half of people with a positive penicillin skin test lose that sensitivity within five years. Among people with a confirmed immediate penicillin allergy, around 80% become tolerant after 10 years.
Penicillin allergy assessments have traditionally been managed by immunologists. However, Dr Nick Cooling, Chair of RACGP Specific Interests Allergy, says GPs could help address the problem by reviewing patients’ allergy histories and assessing their risk.
He told newsGP that the large number of incorrect allergy records makes GP involvement important, particularly given the limited number of immunologists in Australia compared with the GP workforce.
ASCIA has released new adult penicillin allergy management guidelines, supported by online training and other resources. The guidance aims to help GPs assess patients and identify those who may be suitable for having an incorrect penicillin allergy label removed.
A public awareness campaign is also encouraging people with a recorded penicillin allergy to discuss it with their doctor.
Dr Cooling said GPs can begin by asking patients about the original reaction, when it occurred and why it was recorded as an allergy. This history can help determine whether the risk is minimal, low, intermediate or high.
He said the new guidance provides a clearer process for deciding what action is appropriate for each patient.
For people assessed as having minimal risk, the allergy label may be removable following an appropriate clinical assessment. Some patients at low risk may be suitable for an oral penicillin challenge in a medical setting under supervision.
The procedure generally involves giving one or two doses of penicillin by mouth and monitoring the patient for up to two hours. Patients whose history suggests a higher risk may require further assessment through a specialist allergy service.
An Australian economic evaluation found that low-risk hospital patients who underwent penicillin allergy assessment and had the allergy label removed spent an average of 4.41 fewer days in hospital. Hospital costs were also $9,467 lower per patient compared with usual care.
Dr Cooling acknowledged that some GPs may have concerns about the risk of anaphylaxis, the practicalities of testing and the lack of payment for the service.
An application for a Medicare Benefits Schedule (MBS) item to pay GPs for conducting these challenges was under review by the Medical Services Advisory Committee, with a decision expected the following year, according to Dr Cooling. The RACGP’s Specific Interests group also planned to promote the guidelines and provide further education.
Professor Michaela Lucas, a clinical immunology and allergy specialist and Co-chair of the National Allergy Council’s Drug Allergy Working Group, said confirming whether a patient is truly allergic to penicillin can help doctors select the most appropriate antibiotic.
When penicillin allergy is recorded, doctors may need to prescribe alternative medicines. Professor Lucas also highlighted the wider concern of antimicrobial resistance, which can spread through communities and limit treatment choices for serious infections.
Dr Cooling said greater GP involvement could help reduce incorrect allergy records and expand treatment options for patients where appropriate. He added that collaboration between GPs and specialist allergy services would be important.
GPs can access the ASCIA guidelines and the National Allergy Council’s Allergy Assist resource, which offers free online specialist advice and support for allergy diagnosis and management.
New penicillin allergy guidance aims to support GPs
Source: Australasian Society of Clinical Immunology and Allergy (ASCIA), Adult penicillin allergy management guidelines.