Pharmacists could safely assess mislabelled penicillin allergy, study results suggest

Pharmacists and other non-allergy specialist healthcare professionals assessed 97% of trial participants as having no penicillin allergy.
Amoxicillin antibiotic drug capsules

Pharmacists and other non-allergy specialist healthcare professionals could safely remove incorrect penicillin allergy labels without carrying out allergy tests, researchers have concluded.

In a trial at three UK hospitals, non-allergy specialist healthcare professionals, including research pharmacists, delivered direct oral penicillin ‘challenges’ to 126 eligible patients who were labelled as having penicillin allergies.

These patients were given an oral dose of amoxicillin in a safe, clinical environment, supervised by a non-allergy specialist clinical consultant.

The results of the study, published in the Journal of Infection on 6 February 2024 and funded by the National Institute for Health and Care Research, showed that 122 of the participants (97%) were assessed as having no penicillin allergy, with no cases of serious hypersensitivity reactions to the challenge.

Louise Savic, consultant anaesthetist and drug allergy specialist at Leeds Teaching Hospitals NHS Trust, and co-chief investigator and joint senior author of the study, said: “This study demonstrates that a routine programme of de-labelling people who believe they are allergic to penicillin, outside the setting of a specialist allergy clinic, is potentially achievable.

“De-labelling was particularly successful within the outpatient population, suggesting that future efforts might be best targeted to this group in order to maximise benefit.”

Joint-senior author of the study, Siraj Misbah, consultant immunologist at Oxford University Hospitals and national clinical director for the Blood and Infection Programme at NHS England, added: “By demonstrating that allied healthcare professionals with no previous background in allergy are capable of removing a penicillin allergy label, this study provides a low-cost framework for adoption by healthcare systems.”

Commenting on the study, Mark Gilchrist, chair of the Royal Pharmaceutical Society’s (RPS) Antimicrobial Expert Advisory Group, said that it “adds to the growing evidence base of why it is important to review patients with a penicillin allergy”.

“With appropriate risk assessment processes in place, we have an opportunity to remove penicillin allergy labels in particular patients, thereby allowing access to more therapeutic options, minimising potential adverse events and helping to reduce the wider antimicrobial resistance threat,” he added.

In September 2023, the RPS published a penicillin allergy checklist to help pharmacists and other healthcare professionals diagnose whether a patient is allergic to penicillin or not.

According to the RPS, a 2019 study in England reported that 5.9% of patients have a penicillin allergy recorded on their health record, yet fewer than 10% of these patients are likely to have a true allergy to penicillin. This suggests that up to 4 million people across the UK may have an incorrect allergy status record.

For further information on antibiotic allergies, see the following PJ resources:

Last updated
The Pharmaceutical Journal, PJ, March 2024, Vol 312, No 7983;312(7983)::DOI:10.1211/PJ.2024.1.305755

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