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Background
The prevalence of penicillin allergy labels in the general population is 5.9%, with 95% of these labels incorrect on testing.1 2 True allergic reactions to penicillin are less common in children than in adults, with less than 7% of children reacting on re-exposure.3 Erroneous labels of ‘penicillin allergy’ are associated with increased antibiotic resistance, higher healthcare costs and poorer clinical outcomes.4
Despite this, penicillin allergy testing is limited in the National Health Service, conducted only by specialist allergists, leaving many patients unable to access testing. The authors feel that widespread delabelling is therefore only possible through the engagement of clinicians not specially trained in allergy and immunology, referred to as ‘non-allergists’.
Information about the current guideline
The guideline was published in June 2022 by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). It provides a framework for non-allergists working in secondary care to set up a penicillin delabelling service for patients. It is a joint guideline covering adults and paediatrics, with separate sections for both patient groups.
Allergy testing is currently performed in specialist clinics by trained paediatric allergists and immunologists in accordance with previous National Institute for Health and Care Excellence (NICE) guidance (NICE CG183), limiting this service to select patient groups. This guideline gives recommendations for identifying patients at low risk of allergy and a framework for the conduct of drug provocation testing (DPT) by non-allergists. It should be used in conjunction with the BSACI 2015 guideline ‘Management of allergy to penicillins and other beta-lactams’ (box 1).
Useful resources
British Society for Allergy and Clinical Immunology (BSACI) guideline for the set-up of penicillin allergy delabelling services by non-allergists working in a hospital setting https://www.bsaci.org/guidelines/bsaci-guidelines/set-up-of-penicillin-allergy-de-labelling-services-by-non-allergists-working-in-a-hospital-setting/
Management of allergy to penicillins and other beta-lactams https://www.bsaci.org/guidelines/bsaci-guidelines/beta-lactam-penicillin-allergy/
Drug allergy: diagnosis and management https://www.nice.org.uk/guidance/cg183
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Footnotes
X @MDMarikar
Contributors DM approached the journal for interest in the article. The first draft was written by CT with subsequent edits made by DM and CT.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.