The Death of Desensitization—Delabeling the Destroyer

Clinical implications:The birth of point-of-care penicillin allergy testing programs, in particular risk-stratified direct oral challenge (DOC) has brought about the death of penicillin desensitisation. Dear Editor,Penicillin allergy is clinically burdensome to infectious diseases practice, substantially impacting antimicrobial choice and leading to use of suboptimal second line agents (1).Penicillin allergy desensitisation induces a temporary tolerance through incrementally administering increasing amounts of the drug.It is used historically in clinical ID practice to manage patients wit h an immediate allergic reaction deemed too high-risk for allergy testing or where testing is not available (2).With the increased implementation of penicillin allergy inpatient and ambulatory testing programs, we question if this has brought about the death of desensitisation?In a single centre retrospective cohort study we examined patients that underwent penicillin desensitisation, to any oral or intravenous penicillin, before and after introducing an inpatient and ambulatory penicillin allergy programme at a tertiary care hospital in Melbourne, Australia.Our outpatient antibiotic allergy testing program was implemented in 2015 (3) and inpatient service in 2017 (4, 5), as previously described.Six patients (3 female, median 77.5yrs, IQR 75.5-81) underwent a total of 7 penicillin desensitisations from 2012-2017 (3 Benzylpenicillin, 2 Amoxicillin, 1 Flucloxacillin, 1 Ampicillin, Table 1).No desensitisations were undertaken after