Direct Oral Challenge for Penicillin Allergy: A Hospital Implementation Evaluation Via the International Network of Antibiotic Allergy Nations (iNAAN) Study

Clinical Infectious Diseases 2026 Open access

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Authors: Elise Mitri, Sara Vogrin, Camille Paynter, Luke R Fletcher, Jonny Peter, Neil Powell, Sara Barnes, Philip H Li, Ana Maria Copaescu, Nicholas Turner, Fiona James, Richard Sullivan
+88 more Maryam Sherkat Masoum, Matthew Rawlins, Geoff Mackay, Benjamin J Smith, Patricia Kilfoyle, Daniel Forster, Morgan Rose, Raquel Cowan, Kylie Alcorn, Anna Brischetto, Andrew A. Mahony, Andrew M. Redmond, Arindam Chakravorty, Zaal Meher-Homji, Chino Yuson, Simeon Crawford, GR Weeks, Sasheela Sri La Sri Ponnampalavanar, C. H. Katelaris, Priscilla Tran, Jennifer O’Hern, Jack Godsell, Trisha Peel, I. Sandaradura, David New, Candice Holland, Tim Cutfield, Sarah Coghill, Caitlin Hand, Jacob Williams, Jaclyn Bishop, Belinda Lambros, Cascia Day, Courtney Ierano, Natasha E. Holmes, Jay Roberts, SL Fernando, Marlena Klaic, Jason A. Trubiano, for the International Network of Antibiotic Allergy Nations (iNAAN) study group, Kyra Chua, Joseph De Luca, Gemma Reynolds, Evelyn Lorraine Andrews, Daniel G Lapirow, Abby Douglas, Tanya Crichton, Kate Guy, Jessica Jarvis, Tapiwa Rusike, Benjamin Bowen, Martin Keen, Suman Adhikari, Sara Nóbrega, Ekua Brenu, Rachael Roberts, Lilian Whelan, Romeo Torres, Chloe Edwards, Laura Bywater, Jamma Li, Thérèse Boyle, Melanie Figtree, Jessica Bui, Christy El-Khoury, Claire M. Italiano, Elizabeth Leahy, Emily Heke, Antje Lutjen, Kevin Nguyen, Marsus Pumar, Mittal Patel, Madonna Khreish, Nazanin Khorshidi, Amanda Nichols, Maria Deetlefs, Marshe Maharaj, Carrie McDougall, Jason Fok, Frank Thien, Stephen Guy, Kylie D’Arcy-Evans, John Dyer, Melinda Jiang, Saima Ahmad, Janice Chiang, Alicia Neels, Callum Maggs
DOI: 10.1093/cid/ciag083
Cited by: 2
References: 13

Abstract

In this international, multicenter prospective study, implementing penicillin direct oral challenge (DOC) using a digital toolkit was acceptable, feasible, and sustainable. Audit and feedback increased activity, particularly among pharmacists. Safety was maintained across heterogeneous DOC protocols, validating a pragmatic, scalable approach that supports local adaptation.

Fields of Study & Subjects

Drug-Induced Adverse Reactions Contact Dermatitis and Allergies Pharmacovigilance and Adverse Drug Reactions

Publication details

Journal / source
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Volume
82
Issue
6
Pages
e1163–e1170
Publication date
10 February 2026
Language
EN