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Pre-Conference Workshop: ADAPT3 penicillin allergy de-labelling for non-allergists in clinical practice

Thursday 13 August 2026 - Limited to 50 attendees per workshop

EARN 5 CLINICAL CPD POINTS

Workshop Aim: To equip non-allergist healthcare workers at Cape Town hospitals with the knowledge, skills, and confidence to practise high-quality antimicrobial stewardship — including safely identifying and de-labelling low-risk penicillin allergy patients, understanding the evolving landscape of antimicrobial resistance in South Africa, and applying sound principles for the appropriate use of advanced antibiotics against resistant organisms such as carbapenem-resistant Enterobacterales (CRE) and metallo-β-lactamase (MBL) producers. Participants will leave with a practical framework for risk-stratifying penicillin allergy labels using the PEN-FAST tool and the EAACI tiered classification, will be competent to perform direct oral challenges in appropriate clinical settings, and will understand how de-labelling and prudent prescribing together preserve our antibiotic armamentarium. This CPD-accredited workshop impact will be measured at 6 months via the iNAAN app to quantify post-training de-labelling activity.

Learning Objectives: By the end of this workshop, participants will be able to:

  • Articulate the patient-level and public health case for penicillin allergy de-labelling, including the impact on AMR
  • Interpret the iNAAN safety dataset and apply its findings to clinical decision-making
  • Use the PEN-FAST clinical decision rule to screen and risk-stratify patients with penicillin allergy labels
  • Classify patients into Tiers 1–3 using the EAACI consensus risk-stratification framework
  • Plan and safely conduct a direct oral challenge (DOC) for low-risk patients in their clinical setting
  • Recognise and manage adverse reactions to DOC, including mild reactions and anaphylaxis
  • Register on the iNAAN app and commit to capturing de-labelling outcomes for a 6-month follow-up
  • Describe the evolving epidemiology of antimicrobial resistance in South Africa, including the rise of carbapenem-resistant Enterobacterales (CRE) and metallo-β-lactamase (MBL)–producing organisms
  • Apply an evidence-based, stewardship-aligned approach to prescribing advanced antibiotics for CRE and MBL infections
Ready to register for this pre-conference workshop?
TIME THURSDAY 13 AUGUST 2026 – TOPICS SPEAKER DURATION
07:30 Registration and Tea and Coffee
08:00

Welcome, Introduction and Pre-Workshop Survey

  • Complete the pre-workshop knowledge and confidence survey
  • Overview of the ADAPT3 workshop objectives and structure
 Prof Peter 20 min
08:20

Evolving Resistance Patterns in South Africa: The Rise of CRE and MBL

  • Current antimicrobial resistance epidemiology in South Africa and the region
  • The emergence and spread of carbapenem-resistant Enterobacterales (CRE)
  • Metallo-β-lactamase (MBL) producers: mechanisms, detection, and local prevalence
  • Why resistance trends make every prescribing decision – including allergy de-labelling – matter
 Prof Dlamini 30 min
08:50

The Case for De-labelling: Patient Harm and AMR

  • The burden of incorrect penicillin allergy labels on patients and health systems
  • Impact on antimicrobial prescribing, resistance, and stewardship priorities
  • Why non-allergists are essential to solving this at scale
 Prof Peter 20 min
09:10

The Overwhelming Safety Data: The iNAAN Dataset

  • Overview of the iNAAN international multi-centre study (40 hospitals, 8 countries)
  • Safety of direct oral challenge across heterogeneous protocols
  • Positive reaction rates (<5%) and adverse event profile
  • Role of non-allergist clinicians (ID physicians, pharmacists) as key adopters
 Prof Peter 20 min
09:30 Tea and Coffee break
10:00

Cape Town Data: Penicillin Allergy Prevalence and Our iNAAN Experience

  • Findings from the Cape Town point-prevalence survey (3.2% self-reported PA)
  • PEN-FAST risk stratification: 64.6% low-risk in our population
  • The GSH iNAAN implementation: 300 assessments, DOC outcomes, and lessons learned
  • Challenges specific to the South African context (staffing, electronic records, patient follow-up)
 Dr McDougall 20 min
10:20

When Someone Reacts: What Does It Look Like?

  • Reaction profiles from the iNAAN dataset
  • Distinguishing mild expected reactions from true allergic events
  • Practical management of DOC-related reactions
 Dr McDougall 20 min
10:40

The Hong Kong Experience: Nurse-Led De-labelling at Scale

  • Implementation of nurse-led penicillin allergy assessment and DOC in Hong Kong
  • Workforce models, training, and governance for non-allergist de-labelling
  • Outcomes, sustainability, and lessons for other settings
 Prof Li 30 min
11:10 Comfort Break
11:20

The low hanging fruit – intolerance or already tolerated another penicillin

  • The EAACI consensus risk-stratification framework: Tiers 1–4
  • Tier 1 (history-based de-label): non-immune symptoms, family history only, documented prior tolerance, undocumented labels
  • Tier 2 (DOC for unspecified low-risk histories): unknown reaction, non-specific rash
  • Interactive role-play: case vignettes for rapid Tier 1 and Tier 2 identification and de-labelling decisions
 Dr Deetlefs / Dr McDougall 30 min
11:50

Using PEN-FAST to risk stratify – case based examples

  • PEN-FAST clinical decision rule: scoring, interpretation, and clinical application
  • Tier 3 phenotypes: urticaria (not meeting 1-1-1) and mild DEE (not meeting 5-5-5)
  • Interactive case: applying PEN-FAST to a patient with an actual reaction history
  • Differentiating Tier 3 from Tier 4: red flags and when to refer to specialist services
 Dr Deetlefs / Dr McDougall 40 min
12:30 Light lunch
13:30

The Direct Oral Challenge: Where, How, and When to Observe

  • Setting up for DOC: observation space, equipment, anaphylaxis kit, staffing
  • DOC protocol: drug choice (amoxicillin 500mg), single vs. graded dosing, observation period (60–180 min)
  • Vital sign monitoring, patient counselling, and informod consent
  • Managing the post-DOC period: documentation, patient information, and de-labelling the medical record
  • Live demonstration / step-by-step walk-through of a DOC procedure
 Dr Deetlefs / Dr McDougall 30 min
14:00

What do we need to implement in your setting?

  • Hospital policy, EDL
  • Governance, audit, progression criteria, and building a local de-labelling team
 Faculty and audience discussion 30 min
14:30

Appropriate Prescribing for Advanced Resistance: Treating CRE and MBL Infections

  • Principles of antimicrobial stewardship for highly resistant Gram-negative organisms
  • Treatment options for CRE and MBL-producing infections, including newer β-lactam/β-lactamase inhibitor and other advanced agents
  • Choosing, sequencing, and reserving advanced antibiotics to limit further resistance
  • Integrating de-labelling and stewardship: preserving β-lactam options at the bedside
 Prof Dlamini 30 min
15:00

Empowering our champions – we need you and want to support you?

  • Registering on the iNAAN app: live sign-up and walkthrough
  • Using the NAAN app for standardised penicillin allergy assessment and DOC documentation
  • Allergy can support you through the hotline or vula
  • Building your hospital team: identifying a local clinical champion
 Faculty 20 min
15:20

Post-Workshop Survey and Closing

  • Complete the post-workshop knowledge and confidence survey
  • Workshop summary, key take-home messages, and next steps
  • Certificate of completion
 Prof Peter 20 min
15:40 Workshop Ends
Ready to register for this pre-conference workshop?

Disclaimer: The organisers reserve the right to make changes to the conference programme, including speakers, session topics, presentation times, and venues, should circumstances require. Every effort will be made to keep delegates informed of any updates. While all reasonable care has been taken in compiling the programme, the organisers accept no responsibility for any errors, omissions, or changes that may occur.

Please note: You will be able to move freely between the different pre-conference workshop sessions.

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