Outcomes of penicillin allergy de-labelling
A total of 56 patients were successfully de-labelled in the pilot study but a key challenge will be preventing the erroneous reappearance of the penicillin allergy label, according to Daniel Hearsey, Advanced Clinical Specialist Pharmacist – Antimicrobials at the Royal Cornwall Hospital Trust.
The penicillin allergy de-labelling toolkit contained all of the documentation resources needed to undertake the procedure. “It had all of the patient information leaflets, the consent forms, allergy risk-assessment tool and questioning tool as well – so everything we needed to undertake that challenge for the patients”, explains Mr Hearsey.
Most patients were keen to undergo ‘de-labelling’. “The patient information leaflet outlined the benefits of losing that penicillin allergy label and the benefits to their future health needs”, he says. However, a few patients declined to participate in case it prolonged their stay in hospital, he adds.
The drug provocation test involves giving a dose of penicillin – ideally the penicillin associated with the original allergy label – under careful observation. Baseline observations were recorded and then every 15 minutes for one hour. “If we were unable to identify the index penicillin we would use amoxicillin 500 milligrams”, he notes. “While we were watching the patient we had an EpiPen available and a loud voice to shout the clinical teams if we needed help – if anything did go awry”, he explains. No immediate reactions occurred but two patients reported later adverse effects – “One patient had a delayed skin reaction at day six and one patient had an episode of thrush”, says Mr Hearsey. The rash on day six was outside the study parameters (which called for monitoring for five days post-test) and it was uncertain whether the episode of thrush was related to the test dose of penicillin.
One of the key challenges is how to prevent the penicillin allergy label from reappearing later, perhaps as a result of another clinician finding it in previous records, Mr Hearsey acknowledges. “With the study materials we make sure to provide the patient with an information leaflet so they can show that to their GP and other healthcare providers. We wrote to the GP and also took their allergy history or label off our system at this point but we have seen that there’s that risk of it reappearing or getting added on a later date if the records aren’t updated in a timely manner”, he says.
In summary, he says: “We’ve shown that this intervention is safe and effective. We were able to de-label 56 patients overall [in the] pilot study, so the next steps are to embed this into our standard of care now.”