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P48 Paediatric penicillin de-labelling study
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  1. Emma McDonald
  1. Southern Health and Social Care Trust, UK

Abstract

Background An estimated 2.7 million people in the UK are thought to be labelled with a penicillin allergy,1 however, approximately 95% of penicillin allergy labels are incorrect when tested further.2 Children (especially those under 4 years of age) often develop mild rashes when given antibiotics, however, these reactions rarely happen again on further testing.1 Despite the known risks of an incorrect penicillin allergy diagnoses, and the potential association with patient harm,3 penicillin allergy testing is a rare NHS resource.4 Recent studies have shown that patients can be identified that are low risk of penicillin allergy via history taking alone.1 These patients can be safely offered direct drug provocation tests (DPT) without prior skin testing.1 Many of these studies have been led by non-allergists such as pharmacists and nurses, working under immediate or remote medical supervision.1

Aim The aim of this study is to carry out DPT for paediatric patients reporting a diagnosis of penicillin allergy and remove this allergy status from their medical records in primary and secondary care.

Method A member of the paediatric multidisciplinary team via inpatient and outpatient reviews will identify patients suitable for de-labelling. Patients referred from primary care may also be recruited. A history will be taken from the patient or carer to ascertain allergy risk status. If allergy history reports only minor ‘low risk’ symptoms (or those reported in study inclusion criteria), and does not report any ‘high risk’ symptoms (or those reported in study exclusion criteria), the patient will be further assessed by member of the medical team. If deemed medically fit, oral DPT will be carried out.

Results This study is ongoing; however, results so far are as follows. A total of 24 patients have been recruited. These patients have been identified via inpatient allergy status reporting on admission/medicines reconciliation, allergy status ascertained at outpatient clinics, or referrals from primary care.

Over one third of patients (37.5%, N=9/24) have successfully passed DPT, completing their course of penicillin based antibiotic with no adverse effects. These patients have also had their allergy status successfully removed from their medical records.

A further approximate third of patients (37.5%, N=9/24) were unfortunately excluded from the study due to reporting symptoms that were listed in the exclusion criteria of the study. The main reasons for exclusion included, rash affecting over 10% of body surface area and rash lasting over 24 hours in duration.

A further quarter of patients (25%, N=6/24) identified so far have not carried out their DPT yet as they were not medically fit enough at the time of identification, however these patients are booked in to future clinics.

Conclusion This study so far has shown that using the allergy history alone, alongside the study’s inclusion and exclusion criteria, has successfully identified patients eligible for DPT without prior skin testing. The patients identified and tested so far have all passed the DPT successfully, which is encouraging. Further testing is necessary to investigate and obtain more results to support this method of de-labelling.

References

  1. Savic L, Arden-Jones M, Avery A, et al. BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. Clin Exp Allergy. 2022;52:1135–1141.

  2. Macy E, Ngor EW. Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin and oral amoxicillin. J Allergy CIin Immunol Pract. 2013;1:258–263.

  3. Healthcare Improvement Scotland, SAPG. Penicillin Allergy Delabelling. Accessed via www.sapg.scot/guidance-qi-tools/quality-improvement-tools/penicillin-allergy-de-labellingon 01/07/2023.

  4. Royal Coll Physicians. Allergy: the Unmet Need. The Lavenham Press Ltd; 2003. https://www.bsaci.org/wp-content/uploads/2020/02/allergy_the_unmet_need.pdf (Accessed 6 July 2023).

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