Patients' experiences of penicillin allergy evaluation: a qualitative study

Penicillin allergy is often overdiagnosed, with a 10% reported prevalence in affluent countries. Incorrect labels lead to broad-spectrum antibiotic use, longer hospital stays and MDR infections. Understanding patients' perspectives is crucial to enhance de-labelling and ensuring penicillin use when indicated. To describe patients' experiences of being labelled as allergic to penicillin and their willingness to take penicillin after a negative challenge.

Fifteen patients referred for allergy investigation were included and participated in semi-structured interviews, regardless of allergy risk or subsequent evaluation results. The data were analysed with qualitative content analysis using the Graneheim and Lundman approach.

Three main categories were identified: 'Frustration over insufficient documentation and communication', 'Factors that determine whether participants want to undergo a drug challenge' and 'What happens after drug challenge? Willingness to accept penicillin after the allergy work-up'. Poor documentation led to insecurity. Trust in healthcare professionals and awareness of the negative consequences of allergy labels contributed to participants' acceptance of drug challenges. The participants were willing to take penicillin after a negative challenge, although some preferred the first dose of subsequent treatments to be administered close to advanced healthcare infrastructure.

Improved and comprehensive guidelines for the management of suspected penicillin allergy are necessary to enhance understanding of penicillin allergy and ensure that patients are promptly evaluated after a suspected allergic reaction with referral to an allergist if indicated.