Bridging Global Disparities in Drug Allergy Through AI-Assisted Training for Non-Specialists: Findings From the Multinational ADAPT-2 Course.

Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
Published Date: Jan 20, 2026

Abstract

BACKGROUND: Mislabelled drug allergy (DA) remains a global public health challenge. A prior randomised trial (ADAPT) demonstrated that an intensive educational course improved DA knowledge and confidence among non-specialists. However, ADAPT was restricted to English-speaking participants and its generalisability remains unknown. To address this, a multinational implementation study expanding ADAPT (ADAPT-2) was performed. METHODS: Non-allergist physicians from Colombo (Sri Lanka), Guangzhou and Shenzhen (Mainland China), Hong Kong (Special Administrative Region of China) and Perth (Australia) completed a standardised DA educational course. In Mainland China, training was delivered via AI-assisted video localisation (converted into Mandarin while preserving the speaker's voice with lip-synced adaptation). DA knowledge, confidence and practice were assessed before and after completion. Subgroup analyses compared pre-post changes between Advanced Economies (AE: Australia, Hong Kong) and Emerging Economies (EE: Mainland China, Sri Lanka). RESULTS: Of 181 participants, overall baseline knowledge (53.5% ± 17.2%) and confidence (47.5% ± 22.7%) scores were suboptimal. EE participants had a lower knowledge level than AE (49.1% ± 15.5% vs. 70.1% ± 12.7%; p < 0.001). Following ADAPT-2, both knowledge (72.5% ± 16.0%, p < 0.001) and confidence (71.3% ± 17.5%, p < 0.001) scores significantly improved across all groups. ADAPT-2 delivered by AI-assisted video localisation was non-inferior to the English course in effectiveness (p > 0.05) and achieved high participant satisfaction (98.9% as 'somewhat clear' or better in clarity). CONCLUSIONS: Deficits in DA knowledge persist widely among non-specialists, with marked disparities between AE and EE. ADAPT-2 bridged these gaps by universal improvements in both DA knowledge and confidence. AI-assisted training represents a scalable, equitable strategy for global implementation of standardised and evidence-based DA education. TRIAL REGISTRATION: ADAPT: NCT06399601.

Authors

  • Hugo W F Mak
    Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
  • Juan Meng
    Key Laboratory of Luminescence and Optical Information, Beijing Jiaotong University, Ministry of Education Beijing 100044 China [email protected] [email protected].
  • Freya K L Chung
    Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
  • Jasmine T Y Lee
    Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
  • Inoka Sepali Aberathna
    Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • Uvini Amarasekara
    Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • Thushali N D Ranasinghe
    Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • Jeewantha Jayamali
    Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • Qintai Yang
    Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: [email protected].
  • Min Zhou
    Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
  • Liang Chen
    Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
  • Jin-Xian Huang
    Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
  • Weihong Shi
    Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
  • Rishabh Kulkarni
    Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
  • Jonny Grant Peter
    Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
  • Jason A Trubiano
    Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia.
  • Kamal Chandima Jeewandara
    Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • Michaela Lucas
    Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
  • Philip H Li
    Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.

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