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Participants report ‘unverified’ allergies mostly to antibiotics, NSAIDs & paracetamol 

 

Prof Guwani Liyanage

By Kumudini Hettiarachchi  

It is no longer an assumption but based on facts – there is an overall 5.8% prevalence of reported unverified drug allergies in Sri Lanka, with the culprits most frequently implicated being antibiotics, specifically penicillins, non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.

This has been uncovered by a large cross-sectional, observational study with 12,491 adult participants (18 years or over) carried out at outpatient clinics in six public sector secondary and tertiary healthcare centres representing the whole of Sri Lanka.

Conducted from December 2024 to April 2025, the study has been published online in the prestigious ‘Lancet’ journal in August 2026 titled ‘The prevalence and risk factors of drug allergy in Sri Lanka – a multi-centre cross-sectional observational study (2024–2025)’. It had been funded by the Institute of Global Innovation, University of Birmingham, United Kingdom.

“We wanted to determine the prevalence of self-reported and physician-documented drug allergies in Sri Lanka and explore potential risk factors associated with drug allergy labels,” the Principal Researcher, Prof. Guwani Liyanage of the Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, told the Sunday Times.

This study carried out through one-on-one interviews in all three languages (English, Sinhala and Tamil) had been conducted at theColombo South Teaching Hospital, Kalubowila (Colombo District); the Colombo North Teaching Hospital, Ragama (Gampaha District); the National Hospital, Galle (Galle District); the Batticaloa Teaching Hospital (Batticaloa District); the Anuradhapura Teaching Hospital (Anuradhapura District); and the Nawalapitiya District General Hospital (Kandy District).

Explaining that the study was held across a wide geographical area representing the north, south, east, west and central provinces of Sri Lanka, Prof. Liyanage said it also covered the urban population (Colombo North and Colombo South Teaching Hospitals); rural & estate populations (Nawalapitiya District General Hospital); and mixed populations (Galle National Hospital and Batticaloa and Anuradhapura Teaching Hospitals).

Colombo North Teaching Hospital had 2,678 participants; Colombo South Teaching Hospital had 2,612; Galle National Hospital had 2,080; Anuradhapura Teaching Hospital had 1,584; Batticaloa Teaching Hospital had 1,568; and Nawalapitiya District General Hospital had 2,142.

The profile of the 12,491 study participants was: Females – 8,410 (67.4%) and males – 4,081 (32.6%), with the average age being 55.1 years. The female-to-male ratio was 544 (74.8%) to 183 (25.2%).

The eye-opening findings were:

727 participants reported 868 drug allergy events.

The majority reported an allergy to one drug (635 participants or 87%), while 92 participants (12.6%) reported an allergy to two or more drugs.

Antibiotics were implicated as the leading drug class with 360 or 41.5% allergy events; NSAIDs having 113 or 13% allergy events; and paracetamol with 92 or 10.6% allergy events, followed by other drug classes.

Among the reported antibiotic allergy occurrences, most were due to beta-lactams bactericidal antibiotics such as penicillins and cephalosporins (239 or 79.1% participants), followed by non-beta lactams (39 or 12.9% participants) and unknown antibiotics (24 or 7.9% participants).

As the age increased, the proportion of participants reporting a drug allergy also increased – 70.3% of all reported drug allergies were among those over 50 years of age, with the highest representation in the 60-93 age group (43.1%).

Most of the allergic reactions had been classified as high risk (215 or 65.4% of participants), compared to low risk (114 or 34.6% of participants).

Predominantly urban Colombo and Gampaha reported the highest rate of drug allergies

Forty per cent of patients carried an allergy card listing their drug allergies, and 89% reported making their doctor aware of their allergies prior to receiving treatment.

Seven per cent of all participants, regardless of their allergy status, had reported self-medication with antibiotics without a valid prescription from a healthcare professional.

The other study team members were Dr. Nadisha Badanasinghe of the Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya; Prof. Dhanushka Dasanayake of the Department of Immunology, Medical Research Institute, Colombo; Prof. Shamini Prathapan of the Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura; Prof. Robert M. West of the School of Medicine, University of Leeds, UK; Dr. Wasana Kudagammana of the Department of Microbiology, Faculty of Medicine, University of Peradeniya; Dr. Vaithehi Francis of the Department of Pathophysiology, Faculty of Healthcare Sciences, Eastern University; Dr. Nayani Suraweera of the Department of Paediatrics, Faculty of Medicine, University of Rajarata; Paula Avello of the Leeds Institute of Health Sciences, University of Leeds, UK; Prof. Pushpika Jayawardana of the Department of Paediatrics, Faculty of Medicine, University of Ruhuna; and Prof. Mamidipudi Thirumala Krishna of the Department of Immunology and Immunotherapy, School of Infection, Inflammation and Immunology, University of Birmingham and Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, UK.

The study may be accessed at Lancet Reg Health Southeast Asia. 2026 Jun 16;51:100804. doi: 10.1016/j.lansea.2026.100804

Suggestions for the way forward

The study recommendations to improve drug allergy services in Sri Lanka include the creation of clear referral pathways so that patients can access specialist care when needed.

“Improve access to allergy testing, especially for suspected penicillin allergy; review existing allergy labels to identify people who may not have a true allergy and increase public awareness about antibiotic use, self-medication and drug allergies,” the study suggests.

Timely advice to the public

With regard to what the public should know about drug allergies, Prof. Guwani Liyanage underscores that people should not assume that every reaction to a medicine is a drug allergy. Some reactions could be side effects or other adverse effects and are different from true drug allergies.

“Tell your doctor about any previous reaction to a medicine, particularly if you developed breathing difficulty, swelling, widespread rash, fainting or other serious symptoms,” she urges, pointing out that the person should keep a record of medicines that have caused a suspected allergic reaction. “If you have been given an allergy card or documented allergy information, take it with you whenever you seek medical care.”

Prof. Liyanage stresses that people should not start taking antibiotics on their own or use antibiotics left over from a previous illness. Antibiotics should be taken only when prescribed by a doctor. Patients should also not stop or change an antibiotic treatment without medical advice, even if they are feeling better.

Pointing out that if a person has been ‘labelled’ as allergic to penicillin or another important antibiotic, he/she should discuss with their doctor whether they need further evaluation to confirm or disregard the allergy label, she says that an inaccurate allergy label can affect which antibiotics can be prescribed to that person in the future.

“Seek urgent medical attention if you develop symptoms of a severe allergic reaction such as difficulty breathing or swelling of the face or throat, or if you collapse or experience rapidly progressing symptoms after taking a medicine,” advises Prof. Liyanage.

Cautioning people never to ‘deliberately’ take a medicine again to “see whether you are really allergic”, she adds that allergy assessment and, where appropriate, supervised testing should be developed as a national approach to assess and manage suspected drug allergies.

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