Sustaining and spreading penicillin allergy delabelling: A narrative review of the challenges for service delivery and patient safety

Abstract

Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm. This review assesses an emergent evidence base and trend favouring delabelling using direct oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these direct delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems.

Barriers to paediatric penicillin allergy de-labelling in UK secondary care: a regional survey

“…This could be pragmatically tailored to suit local and regional processes to support safe de-labelling on paediatric wards, paediatric assessment units and even in paediatric emergency departments. Of note, an effective de-labelling guideline should lay emphasis on communicating information to primary care providers to remove these labels from medical records 16…”

Genome-wide Study Identifies Association between HLA-B∗55:01 and Self-Reported Penicillin Allergy

“…Previous work has found that most (90%–95%) individuals labeled as having beta-lactam hypersensitivity may not actually have true hypersensitivity by adulthood when they more commonly undergo validated testing. 7 , 8 , 62 , 63 However, we believe that the phenotype we have studied is valid for several reasons. 7 , 62 The most commonly reported penicillin allergy is delayed-type allergy, which usually manifests as a transient benign rash that does not recur on rechallenge many years later.…”

Leveraging implementation science to advance antibiotic stewardship practice and research

“…A wide range of stakeholders could be involved in such a project, including patients, nurses, surgeons, allergists, pharmacists, health system information technology specialists, surgical center administrators, and health system leaders. 38 Once stakeholders are identified, they must be engaged. Although the level of engagement may vary depending on the project, the goal is to ensure that stakeholder needs, preferences, priorities, concerns and beliefs about the evidence-based practice proposed for implementation have been identified and used to inform the study.…”