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Removal of incorrect penicillin allergy labels by non-specialist healthcare professional feasible

97% of patients who were deemed low risk and took part were assessed as not having allergy

19 March 2024
A close-up of three white pills in the palm of a woman's hand

Patients who may have been mis-labelled as allergic to penicillin could be safely offered a dose of the oral antibiotic to demonstrate that they could take it without harm, following a new trial.

In a new study published in the Journal of Infection funded by the National Institute for Health and Care Research (NIHR), academics and clinicians ran a study in three UK hospitals to assess the feasibility of non-allergy specialist healthcare professionals delivering direct oral penicillin ‘challenges’, without doing allergy tests, where low risk patients who think they have a penicillin allergy receive an oral dose and are closely monitored afterwards.

From more than 2000 potentially eligible patients and following screening, 126 took part in the trial which ran in University Hospitals Birmingham NHS Foundation Trust (UHB), Leeds Teaching Hospitals NHS Trust and Oxford University Hospitals NHS Foundation Trust.

Participants were given an oral dose of amoxicillin by a research nurse or a research pharmacist in a safe clinical environment supervised by a non-allergy specialist clinical consultant, with immediate access to resuscitation facilities if needed.

122 of the 126 participants (97%) were assessed as having no penicillin allergy, with no cases of serious hypersensitivity reactions.

Penicillin allergy labels are not benign and contribute to antimicrobial resistance, so enabling more patients to safely benefit from penicillin will ease the burden of other antibiotics.

Professor Mamidipudi Thirumala Krishna

Professor Mamidipudi Thirumala Krishna, Chair of Allergy, Clinical Immunology and Global Health at the University of Birmingham, and corresponding author and Chief Investigator of the study said:

“Inaccurate penicillin allergy labels are a huge burden globally. In High Income Countries such as UK and USA 6-10% percent of the population believe that they are allergic. Penicillin allergy labels are not benign and contribute to antimicrobial resistance, so enabling more patients to safely benefit from penicillin will ease the burden of other antibiotics that are currently being overused and improve quality of clinical care”.

“In our feasibility study, we showed how a closely monitored protocol for taking penicillin directly, rather than using a skin allergy test which needs to be delivered by an allergy specialist, was effective in low-risk patients. This means they can safely use penicillin in the future”.

Dr Louise Savic, Consultant Anaesthetist and Drug Allergy Specialist at Leeds Teaching Hospitals NHS Trust, Co-Chief Investigator and joint senior author of the study said:

“This study demonstrates that a routine programme of de-labelling people who believe they are allergic penicillin, outside the setting of a specialist allergy clinic, is potentially achievable. Delabelling was particularly successful within the outpatient population, suggesting that future efforts might be best targeted to this group in order to maximise benefit.”

Dr Siraj Misbah, joint-senior author, Consultant Immunologist at Oxford University Hospitals and National Clinical Director for the Blood and Infection Programme at NHSE said:

“Inaccurate labels of penicillin allergy constitute a major public health challenge because of its adverse consequences for the individual due to restricted antibiotic access and for wider public health because of its negative impact on antimicrobial resistance and stewardship. By demonstrating that allied healthcare professionals with no previous background in allergy are capable of removing a penicillin allergy label, this study provides a low-cost framework for adoption by healthcare systems.”

Notes for editors

  • For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.

  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 8,000 international students from over 150 countries.
  • The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between seven organisations who collaborate to bring healthcare innovations through to clinical application:
    • University of Birmingham
    • University Hospitals Birmingham NHS Foundation Trust
    • Birmingham Women's and Children's Hospitals NHS Foundation Trust
    • Aston University
    • The Royal Orthopaedic Hospital NHS Foundation Trust
    • Sandwell and West Birmingham Hospitals NHS Trust
    • West Midlands Academic Health Science Network
    • Birmingham and Solihull Mental Health NHS Foundation Trust

  • About the National Institute for Health and Care Research

    The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

    • Funding high-quality, timely research that benefits the NHS, public health and social care;
    • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
    • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
    • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
    • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
    • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

    NIHR is funded by the Department of Health and Social Care. Its work in low and middle-income countries is principally funded through UK Aid from the UK government.

Featured staff

  • Professor Mamidipudi Thirumala Krishna

    Chair of Allergy, Clinical Immunology and Global Health

    Staff profile for Professor Mamidipudi Thirumala (TK) Krishna, Chair of Allergy, Clinical Immunology and Global Health and Honorary Consultant Allergist and Immunologist, University of Birmingham.

    Phone: +44 (0) 121 414 3454
    Email: m.t.krishna@bham.ac.uk

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