Penicillin allergy de-labelling

SAPG has updated its penicillin allergy de-labelling pathway to support removal of inaccurate penicillin allergy labels and improve access to appropriate antibiotic treatment. The PADL pathway now supports direct de-labelling, oral challenge testing and identification of patients who should retain a penicillin allergy label. 

Patient inclusion and exclusion criteria 

Patients will be screened using the Penicillin Allergy De-Labelling (PADL) Algorithm to determine if they are suitable for de-labelling.  

Undertaking a PADL assessment 

  • Take patient’s full penicillin allergy history.  
  • Use PADL algorithm to clinically assess risk of penicillin allergy. 
  • Categorise patients into low risk, medium risk or high risk for penicillin allergy.  

The following patients are excluded from penicillin allergy de-labelling pathways.  

  • Any patients who are deemed as acutely unwell and particularly if haemodynamically unstable. 
  • Patients currently requiring antibiotic treatment for a severe infection. 
  • Patients who are unable to participate in the assessment process or provide written consent for oral challenge where oral challenge is being considered. 

The PADL algorithm gives three possible outcomes following assessment:  

Further information

SAPG encourages feedback from clinical teams about any aspect of the process and invites suggestions for improvements. This can be done via email to his.sapg@nhs.scot.

Scottish Antimicrobial Prescribing Group (SAPG) | Oct 2026 for review Aug 2029

Content update October 2026