Non-allergy healthcare professionals can safely give direct oral penicillin challenges

A study published in the March issue of the Journal of Infection has found that direct oral penicillin challenges can be safely given to patients with penicillin allergy labels by non-allergy healthcare professionals.

The huge number of inaccurate penicillin allergy labels is an important driver of antimicrobial resistance. In addition there are not enough allergy specialists and ‘point-of-care’ tests to be able to safely deliver penicillin.

Researchers from the University Hospitals Birmingham NHS Foundation Trust ran a prospective observational study in three hospitals in three settings (acute medical, pre-surgical, and hematology-oncology) to examine the feasibility of non-allergy healthcare professionals delivering direct oral penicillin challenges for penicillin allergy de-labelling.

A high proportion of patients did not progress in the study. Out of 2257 patients screened and 1054, eligble to take part, 270 consented and 155 were considered low risk. 126 took part in a direct oral penicillin challenge and 122 (96.8%) of those were delabeled with no serious allergic reactions.

The conversion rate from screening to consent was 12% in acute settings and 17.9% in elective settings. Reasons for not progressing through the study were difficulty in reaching patients, clinical instability/medical reasons, lacking capacity to consent, and psychological factors.

The authors concluded that direct oral penicillin challenges can be delivered by non-allergy healthcare professionals. They wrote “Our findings suggest a multipronged approach is needed in the U.K. National Health Service to maximize uptake of DPC”, and “elective settings offer greater opportunities than acute settings”.

Read the study in the Journal of Infection