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Nottingham and Nottinghamshire Integrated Care Board (ICB) has said it is developing a model of penicillin allergy de-labelling that would use existing pharmacy, antimicrobial stewardship teams, primary care and allergy services, in response to the death of patient.
In a ‘Prevention of future deaths’ report, published online on 13 August 2026, Laurinda Bower, coroner for Nottingham City and Nottinghamshire, stated that Jennifer Susan Birch, aged 27 years, died at the Queen’s Medical Centre in Nottingham, on 11 April 2025, as a result of a hypoxic brain injury caused by medication given in the peri-operative period of an elective procedure performed on 8 April 2025.
The coroner wrote that Birch was given intravenous prophylactic antibiotic teicoplanin, which carries a rare but recognised risk of anaphylaxis, instead of flucloxacillin owing to a recorded allergy to penicillin in the form of a rash as a baby.
She added: “The use of teicoplanin in this case was entirely appropriate given Jen’s allergy warning, but it did expose her to a risk of severe anaphylaxis, which materialised and caused her death.
“In the months following Jen’s death, some trusts have rolled out an inpatient initiative to seek to de-label penicillin allergy from patient medical records where risk stratification determines that the patient does not have a true allergy to penicillin.
“The SPACE study established that up to 10% of the population carries documented penicillin allergy, but over 90% of these are inaccurate. False labels have been shown to increase antibiotic resistance, higher surgical site infections, longer hospital stays, as well as exposing patients to unnecessary complications associated with second-line antibiotics.
“One local trust — Doncaster and Bassetlaw NHS Trust — has already rolled out an inpatient PADL [penicillin allergy de-labelling] pathway. The SPACE study proved it is clinically safe and effective for non-allergy healthcare professionals to use approved risk stratification and direct oral penicillin challenges for low-risk patients, ensuring the burden for this pathway does not impact on the often-small secondary care allergy service.”
In a response to the coroner’s report, published on 30 July 2026, Nottingham and Nottinghamshire ICB said it had begun work on developing a stakeholder group that will meet to discuss the most appropriate pathway to facilitate de-labelling in the population.
“With up to 10% of the population affected, it would not be possible for allergy services alone to facilitate this and there will need to be a focused approach with those at highest risk targeted first,” it said.
“To enable a penicillin allergy de-labelling programme to be embedded effectively across a provider organisation, all key professionals who are essential for its success need to be included and engaged with.
“We will use existing pharmacy, antimicrobial stewardship teams, primary care and allergy services to develop a model that will work for the population of Nottingham and Nottinghamshire. We hope to be able to provide support to the NHS England programme to evidence what works well.”
The results of a study published in February 2024 found that pharmacists could safely assess mislabelled penicillin allergies.
In 2022, the British Society for Allergy and Clinical Immunology recommended that “all patients labelled as ‘penicillin allergic’ attending secondary or tertiary care should be considered for penicillin allergy testing.
