Implementation of a proposed algorithm to assess and de-label false penicillin allergy labels in the community

Community pharmacists could have a pivotal role to play in de-labelling false penicillin allergies or preventing false penicillin allergy labels from occurring to reduce inappropriate prescribing of less effective and broader-spectrum antibiotics.

A quasi-experimental study aimed at implementing and evaluating an algorithm to assess and de-label false penicillin allergy labels in the community. Between April and May 2024, the algorithm was rolled out to five community pharmacies in Victoria, Australia. De-labelling outcomes of Type A reactions were recorded. Barriers and enablers to implementing the penicillin allergy assessment algorithm were also collected through semi-structured interviews.

Of 18,646 patients who presented to the pharmacies, 163 individuals (0.87 %) had a penicillin allergy label. Of these 163 patients, 30 (18.4 %) patients were assessed as having a Type A reaction (a non true allergy; non-immune related). All patients with Type A reactions were engaged in an attempt to de-label their allergy; 77 % of patients were accepting whilst 23 % were hesitant or non-receptive, due to time restraints or disbelief that their allergy is not a true allergy. Qualitative interview data revealed there remains a public misconception that antibiotic allergy labels do not impact the appropriateness of antibiotic prescribing or affect patient safety through increased risk of adverse drug events and antimicrobial resistance.

The proposed algorithm was able to support the de-labelleling of false penicillin allergies. Future research could implement the use of the algorithm in other primary care settings and ascertain the long-term retention of the initiation of de-labelleling in the community.