Most penicillin allergy labels in GP records ‘incorrect’, study finds
A study of more than 800 patients has found that most penicillin allergy labels in GP records are ‘incorrect’, pointing to increased antibiotic use and worse health outcomes for patients as a result.
The trial in 51 GP practices found that almost nine in ten patients with a penicillin allergy label on their GP record could have it safely removed.
Participants across four regions of England were randomly assigned to usual care or to a penicillin allergy assessment pathway which involved a penicillin oral challenge, skin challenge or both.
In all 88% of people with a penicillin allergy or sensitivity had their label removed from their medical records.
The trial found that 8% of participants had a positive test and kept their penicillin label, but none had a serious reaction. Those who underwent penicillin allergy checks received fewer antibiotics overall.
When patients had their allergy label safely removed after allergy testing, GPs were five times more likely to prescribe them a first-choice penicillin antibiotic when they needed treatment for common infections, the researchers reported in The Lancet Primary Care.
It is thought more than one in 15 UK adults have a penicillin allergy label on their medical records.
Allergy mislabelling can happen when infection symptoms are mistaken for allergies, or when true allergies disappear over time, the team said.
Identifying incorrect penicillin allergy labelling could also help tackle antibiotic resistance as those patients tend to be offered broader-spectrum antibiotics which increases the risk of multi-drug resistance.
Penicillin allergy testing is not yet widely available across the NHS with limited capacity in allergy services, but the research team said they were now working with colleagues to plan how to widen access to assessment for patients.
Study lead Dr Jonathan Sandoe, associate clinical professor of medical microbiology at the University of Leeds, told Pulse that the study showed that penicillin allergy labels are common, often incorrect and causing harm to patients.
Her said: ‘Incorrect labels can be corrected by a penicillin allergy assessment which should be undertaken by appropriately trained healthcare professionals.
‘GPs can remove penicillin allergy labels from patients whose history suggests there is no risk of penicillin allergy according to current guidelines. However, our previous research has suggested that GPs are reluctant to do this.’
He added: ‘Currently there isn’t capacity for GPs to assess themselves, or refer, all patients with a penicillin allergy record, but the NHS is working to try and widen access to penicillin allergy assessment.’
Dr Sandoe added that under NICE guidelines, patients can be referred for penicillin allergy assessment if they have need for repeated penicillin courses or can only be treated with a penicillin.
He said: ‘However, the guidelines need updating in light of new evidence. Research is being planned to find out how GPs would feel about delabelling patients who are at very low risk of a true allergy and we would like to encourage GPs and patients to participate in this kind of research.’
Co-author Christopher Butler, professor of primary care in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said: ‘This innovative and timely study proves the principle that there are feasible, implementable ways of having people safely delabelled as penicillin allergic, and that this means they are able to receive more appropriate care when they next get an infection.’
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