INACCURATE penicillin allergy labels (PAL) contribute significantly to antimicrobial resistance, a pressing global health concern. The issue is exacerbated by a shortage of allergy specialists and a lack of ‘point-of-care’ tests. In a recent study led by a team from the University Hospitals Birmingham National Health Service (NHS) Foundation Trust, UK, it was found that direct oral penicillin challenges (DPC) can be delivered to patients with PALs by non-allergy healthcare professionals (HCP).
The research aimed to evaluate the safety and effectiveness of DPCs in penicillin allergy delabelling across three different hospital settings: acute medical, presurgical, and haematology–oncology. Patients with PALs were screened for eligibility, and then stratified as low- or high-risk based on specific criteria, such as non-immune-mediated symptoms, benign rash, tolerated amoxicillin since registration of PAL, and family history. Low-risk patients underwent a DPC administered by non-allergy HCPs.
A total of 2,257 patients with a PAL were screened, 1,054 of whom were found to be eligible, and 643 were approached for the study. Out of those approached, 270 patients consented to participate and 259 of these were risk stratified (155 low-risk; 104 high-risk). Of the low-risk patients who underwent DPC, 96.8% (n=122) were successfully delabelled without experiencing any serious allergic reactions.
These findings indicate that DPCs can be safely and effectively delivered by non-allergy HCPs, which has the potential to address the burden of inaccurate PALs. However, a high proportion of patients did not progress in the study pathway, with a conversion rate from screening to consent of only 12%. Common reasons for failure to progress in the study included difficulty in reaching patients, clinical instability or medical reasons, lack of capacity to consent, and psychological factors. This highlights the need for strategies to deliver DPCs at optimal points of the care pathway to enhance uptake.
References
Krishna MT et al. A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling ‘low risk’ patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): implications for healthcare systems. J Infect. 2024;88(3):106116.
