A recent study published in the Journal of Infection demonstrates the feasibility and safety of utilizing nonallergy healthcare professionals (HCPs) to administer direct oral penicillin challenges (DPCs) for patients with penicillin allergy labels (PALs). Led by Mamidipudi Thirumala Krishna, M.B.B.S., Ph.D., from the University Hospitals Birmingham NHS Foundation Trust in the United Kingdom, the study explores the potential of nonallergy HCPs to conduct DPCs for penicillin allergy delabeling across various hospital settings.
Key Findings:
The prospective observational study, conducted in three hospitals covering acute medical, presurgical, and hematology-oncology departments, involved screening patients with PALs and stratifying them based on risk levels (low risk/high risk). Low-risk patients were selected to undergo DPCs.
Out of 2,257 PALs screened, 1,054 were deemed eligible for the study. A total of 270 participants provided consent, with 259 being risk-stratified (155 low risk; 104 high risk). Among the low-risk patients who underwent DPCs, 96.8 percent were successfully delabeled without experiencing serious allergic reactions.
The study revealed varying conversion rates from screening to consent across different hospital settings, with higher rates observed in hematology-oncology (17.9 percent) and presurgical (12 percent) settings. Common barriers to progression in the study included difficulty in reaching patients, clinical instability, lack of capacity to consent, and psychological factors.
Implications:
The findings underscore the potential for expanding the role of nonallergy HCPs in conducting DPCs for penicillin allergy delabeling, thereby optimizing healthcare resources and improving patient access to appropriate antibiotic treatments. The authors advocate for a comprehensive approach within the U.K. National Health Service to enhance the uptake of DPCs, addressing barriers to consent and implementation effectively.
