New developments in evaluating and testing patients with an unsubstantiated label of penicillin allergy

21st September 2022

The British Society for Allergy and Clinical Immunology (BSACI) has announced the publication of the BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting.

Penicillin allergy labels are associated with antimicrobial resistance (AMR), are less effective in healthcare and increase healthcare costs. Most penicillin allergy labels prove to be incorrect when tested, therefore removal of an incorrect label is a key strategy for improving antimicrobial stewardship and reducing patient harm from alternative antibiotics.

This new guideline provides a framework for the set-up and delivery of penicillin allergy de-labelling services by non-allergists with an interest in clarifying the penicillin allergy status in adults and children with an untested label of penicillin allergy.

The BSACI, allergy experts and a range of key stakeholders, have collaborated on the development of the BSACI guideline, where a label of penicillin allergy is carried by 5.6% of the general population, with an estimated 2.7 million people in the UK affected.

The recommendations identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate recommendations for adults and children within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy. 

Being able to define which patients are suitable for a direct penicillin provocation test, without prior skin testing is a huge breakthrough and the minimum safety standards required to conduct a provocation test. for non- experts will change the lives of those patients who for many years have been living with this label.

Professor Graham Roberts, President of BSACI explains:

‘We are delighted that BSACI have led with our stakeholders on the publication of the de-labelling of penicillin allergy in a hospital setting by non-allergists. It will provide an important framework going forward for non-allergists with an interest in clarifying the penicillin allergy status of their patients with an untested label of penicillin allergy.’

Patient and co-author Rochelle Gold explains:

‘I had a label for penicillin allergy in my medical notes since childhood. I’d had many bouts of tonsillitis that was treated with it. I was always physically sick so my family wrongly assumed that this was because I was allergic to penicillin and this became part of my medical history. Being part of a de-labelling programme not only enabled me to test this assumption – I also learnt the importance and value of being able to take penicillin.’ 

The recommendations summarised in this guideline are endorsed by The Royal College of Pathologists, Association of Anaesthetists, Royal College of Anaesthetists, Royal College of Physicians, Royal College of Physicians (Edinburgh), British Infection Association, Society for Acute Medicine, British Association of Dermatologists, Royal Pharmaceutical Society, British Society of Antimicrobial Chemotherapy and Allergy UK.

Access the BSACI guideline for de-labelling of penicillin allergy in a hospital setting by non-allergists at www.bsaci.org/guidelines/bsaci-guidelines/

For media enquiries contact info@bsaci.org