New BSACI guidelines for the de-labelling of penicillin allergy

The British Society for Allergy and Clinical Immunology (BSACI) has developed new guidelines for healthcare professionals who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de-labelling service for their patients.

An estimated 2.7 million people in the UK are labelled as “penicillin allergic’ but 95% of penicillin allergy labels are incorrect when tested. Over the past 10 years, researchers have seen an increase in the risk of infections and death in patients diagnosed with penicillin allergy. This is believed to be due to increased use of alternative antibiotics, which increases the duration of hospital admissions and has a significant implication for the cost of health care.

Despite this, penicillin allergy testing is rare in the NHS and testing is currently only performed by allergists and immunologists working in specialist clinics. This means the majority of patients labelled as penicillin allergic won’t be tested. Researchers believe the only way to meet the current and future demand is to involve non-allergist clinicians.

The aim of the new guidelines is to provide the framework for the set-up and delivery of penicillin allergy de-labelling services by non-allergist and applies only to adults in a hospital setting. The guidelines detail appropriate patient selection, risk stratification, minimum safety standards, conduct of a drug provocation test and the degree of oversight required from allergy or immunology specialists. More research was needed before these could become a standard of care for children.

Read BSACI’s full guidelines here.

For more information on drug allergy, see our Factsheet.