DALES - a prospective cross-sectional study of incidence of penicillin allergy labels, risk of true allergy and attitudes of patients and anaesthetists to de-labelling strategies

Abstract

<jats:p>Background Direct drug provocation testing (DPT) in patients with low-risk penicillin allergy labels would allow population-level de-labelling. We sought to determine the incidence and nature of penicillin allergy labels in a large UK surgical cohort and to define patient and anaesthetist attitudes towards penicillin allergy testing. Methods A prospective cross-sectional study was performed in 213 UK hospitals. Penicillin allergic patients were interviewed and risk-stratified. Knowledge and attitudes around penicillin allergy were defined in patients and anaesthetists, determining potential barriers to widespread testing. Findings Of 21,281 patients 12% self-reported penicillin allergy and 67% of these were potentially suitable for direct DPT (stratified low or intermediate risk). Irrespective of risk category 62% wanted allergy testing. Of 4,978 anaesthetists 40% claimed to routinely administer penicillin when they judge the label to be low-risk; 64% would then tell the patient they had received penicillin. Only 47% of all anaesthetists would be happy to administer penicillin to a patient previously de-labelled by an allergy specialist using direct DPT; the commonest reason not to administer penicillin was perceived lack of support from their hospital. On the study days, 13% of low-risk patients requiring penicillin received it, and 6 patients with high-risk labels received it. There were no adverse events in any of this group. However, 1 patient who received an alternative antibiotic suffered suspected anaphylaxis to this. Interpretation The majority of patients with a penicillin allergy label may be suitable for direct DPT and demand for testing is high among patients. Anaesthetists demonstrate inconsistent, potentially unsafe prescribing in patients labelled as penicillin allergic. More than half of anaesthetists are not reassured by a negative DPT undertaken by a specialist. Significant knowledge gaps may prevent widespread de-labelling being effectively implemented in surgical patients.</jats:p>