Related Experiment Video
Updated: Jul 25, 2025
Removal and Replacement of Endogenous Ligands from Lipid-Bound Proteins and Allergens
Published on: February 24, 2021
Removal of incorrect penicillin allergy labels in a UK hospital
Daniel Hearsey1, Shuayb Elkhalifa2, Jonathan Sandoe3
1Pharmacy Department, Royal Cornwall Hospital Trust, Truro, UK.
Objectives:
Penicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital.
Methods:
A daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use. An allergy history was taken before risk stratifying likelihood of future harm from penicillin re-exposure and an allergy testing method was determined (direct de-label on history alone or after direct drug provocation testing). After successful allergy de-label, the antibiotic was switched to a penicillin antibiotic.
Results:
Of 7214 inpatients during the study period, 1133 (15.7%) had a penicillin allergy record. Of 285 allergy histories taken, 105 (36.8%) met high-risk criteria, 45 (15.8%) met low-risk criteria eligible for direct de-label and 73 (25.6%) met criteria eligible for direct drug provocation testing. We were unable to obtain a history for 61 (21.4%) patients. Of 45 low-risk patients eligible for direct de-label, 40 (88.9%) were de-labelled of whom 24 (53.3%) were switched to a penicillin antibiotic. Of 73 patients with a low-risk allergy history eligible for direct drug provocation testing, 16 (21.9%) received direct drug provocation testing, of whom 9 were switched to a penicillin antibiotic. Two direct de-label patients experienced harm (thrush within 5 days and delayed skin reaction after day 5); none of the direct drug provocation testing patients had a reaction by day 5. The switches resulted in reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs).
Discussion:
Penicillin allergy de-labelling patient pathway delivered by pharmacists and junior doctors was safe and effective and well accepted by patients and the wider clinical teams.
Insights
A pharmacist-led penicillin allergy de-labelling program safely and effectively removed incorrect allergy records in a UK hospital. This initiative reduced broad-spectrum antibiotic use by reintroducing penicillin antibiotics.
Area of Science:
- Clinical Pharmacy
- Infectious Diseases
- Allergy & Immunology
Background:
- Penicillin allergy records are frequently inaccurate and lead to the overuse of broad-spectrum antibiotics.
- Incorrect penicillin allergy labeling is a significant issue in healthcare settings, impacting treatment choices and antimicrobial stewardship.
Purpose of the Study:
- To pilot a pharmacist-led, multidisciplinary penicillin allergy de-labelling ward round in a UK hospital.
- To assess the feasibility and effectiveness of a structured pathway for penicillin allergy de-labelling.
Main Methods:
- A daily ward round identified patients with penicillin allergy records preventing first-line penicillin use.
- Patient allergy histories were taken, risk-stratified, and appropriate de-labelling methods (direct de-label or drug provocation testing) were determined.
- Successful de-labelling led to switching patients to penicillin antibiotics.
Main Results:
- Out of 7214 inpatients, 15.7% had a penicillin allergy record. Histories were obtained for 285 patients, with 36.8% high-risk, 15.8% low-risk for direct de-label, and 25.6% eligible for drug provocation testing.
- 88.9% of low-risk patients eligible for direct de-label were successfully de-labelled, with 53.3% switched to penicillin. 21.9% of patients eligible for drug provocation testing underwent testing, with 9 switched to penicillin.
- Two patients experienced minor harm after direct de-labelling; no reactions occurred with drug provocation testing. Antibiotic switches reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs).
Conclusions:
- The pharmacist-led penicillin allergy de-labelling pathway is safe, effective, and well-accepted by patients and clinical teams.
- This intervention demonstrates a successful strategy for improving antibiotic prescribing and reducing unnecessary broad-spectrum agent use.
Related Concept Videos
01:27Allergic Drug Reactions
02:06Allergic Reactions
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...