Establishing a clear penicillin allergy assessment pathway (PAAP) in a safe clinical setting can be effective in ‘de-labelling’ patients wrongly thought to be allergic to penicillin, according to a recently published study led by researchers from the University of Oxford and University of Leeds.
It is thought that 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.
The Allergy Antibiotics And Microbial Resistance (ALABAMA) trial, designed to address incorrect penicillin allergy records in primary care, investigated patients’ experience of penicillin allergy testing (PAT) and their acceptance of de-labelling following a negative allergy test. This was conducted in hospital settings, but had some potential learnings for primary care.
The researchers conducted and analysed interviews with 28 patients in the PAAP intervention arm of the trial. Of these, two received a positive PAT result and 26 received a negative PAT result.
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Before attending the test at a hospital clinic, patients received a ‘Going for a test’ booklet, which provided information on incorrect allergy records, why they would benefit from PAT, and what the test would involve.
Following the test, patients received the result by letter, together with a ‘negative test result’ leaflet (where applicable) and a card confirming the negative result to show other healthcare professionals as needed.
The ‘negative test result’ leaflet informed patients of the reliability of the PAT and consequences of a negative test result.
Following the tests, among the 26 patients receiving a negative result, 24 accepted and two declined de-labelling.
The researchers noted that at the point of study recruitment, many patients already doubted that they were allergic to penicillin.
They also found that patients were happy to attend testing at the hospital. These factors led to most people trusting their negative test result and accepting de-labelling.
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In addition, the trial found that clear communication of the change of their allergy records also supported patients in accepting the de-labelling.
‘Having that conversation with a GP made patients more confident in accepting the new label and in their intention to take penicillin in the future,’ the study observed.
‘Patients were reassured when they knew their record had been changed and when a healthcare professional acknowledged and was supportive of this change.’
According to the project, some patients indicated a preference to discuss the change with their GP, while others said they would be happy with ‘quick confirmation’ from their healthcare team, such as in a text message.
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Some patients just wanted to be reassured that their medical record had been changed and actively followed this up with their practice, while others trusted the process and did not need confirmation that their records had been updated.
While the ALABAMA trial’s testing was conducted in hospital settings, the researchers note that confidence in the test’s safety and reliability may be harder to replicate in other environments. They call for further work to enable safe, effective de-labelling services across both primary and secondary care.
