Removing incorrect penicillin allergy labels in a UK hospital

Incorrect penicillin allergy labels can result in patients receiving less effective or more toxic antimicrobial agents but a pilot study has shown that a pharmacy-led multidisciplinary team can safely ‘de-label’ many patients. In this series of short videos, Daniel Hearsey, Advanced Clinical Specialist Pharmacist – Antimicrobials at the Royal Cornwall Hospital Trust, describes how the study was done and how the findings might be implemented more widely.

Why should we de-label ‘penicillin-allergic’ patients?

Penicillin allergy is commonly over-reported and patients are often incorrectly labelled as being allergic to penicillin. Removing incorrect penicillin allergy labels can improve patient care by effectively making penicillin available to patients and reducing unnecessary use of broad-spectrum antibiotics, Mr Hearsey explains.  A detailed allergy history is required to determine whether there is a high or low risk of having a true penicillin allergy. The low-risk group was separated into those eligible for direct de-labelling on history alone and those eligible for direct drug provocation testing.

The British Society of Allergy and Clinical Immunology (BSACI) recently published guidelines to help non-allergists to set up penicillin allergy de-labelling services, he says.

The penicillin allergy de-labelling toolkit contained all of the documentation resources needed to undertake the procedure. The drug provocation test involved giving a dose of penicillin under careful observation.

A total of 56 patients were successfully de-labelled in the pilot study and the next step is to embed this into the standard of care at the hospital.  A key challenge will be preventing the erroneous reappearance of the penicillin allergy label, acknowledges Mr Hearsey.

Read and watch the full series on our website or on YouTube.