Patients' acceptance of a penicillin allergy de-labelling programme in primary care: a qualitative study

About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these people are likely to be truly allergic. Consequently, a significant portion of the population is denied first-line antibiotics. The ALlergy AntiBiotics And Microbial resistAnce (ALABAMA) trial aimed to determine if a penicillin allergy assessment pathway (PAAP) was safe and effective in de-labelling patients as allergic and improving antibiotic prescribing and patient health outcomes.

To investigate patients' experiences of penicillin allergy testing (PAT) and their acceptance of de-labelling following a negative allergy test.

This was a qualitative study using semi-structured interviews with patients who took part in the PAAP intervention arm of the ALABAMA trial.

As part of a mixed-methods process evaluation embedded in the ALABAMA trial, we conducted interviews with patients in the PAAP intervention arm. Data from interviews with patients were analysed using thematic analysis.

Of the 28 participants interviewed, two received a positive PAT result and 26 received a negative PAT result; of these, 24 accepted and two declined de-labelling. At point of trial recruitment, many patients already doubted that they were allergic to penicillin. Patients were happy to attend PAT and felt cared for and safe at the hospital. These factors led to most people trusting their negative test result and accepting de-labelling.

The patients we interviewed engaged with the PAAP intervention and, when testing negative, were predominantly willing to have their allergy record changed and to take penicillin in future. We highlight factors that influenced patients' acceptance of de-labelling to facilitate future adoption of PAAP. These factors, which should be considered when planning for penicillin allergy testing services, were as follows: patients identifying themselves as low risk before the test; PAT being perceived as trustworthy and safe; patients' previous experience of penicillin allergy and reactions; patients' understanding of penicillin reactions; and clear communication after de-labelling.