A clinical pharmacist from Truro has been funded by the National Institute for Health and Care Research (NIHR) to investigate the best way to treat patients incorrectly labelled as ‘allergic’ to penicillin.

Neil Powell, a consultant antimicrobial pharmacist at Royal Cornwall Hospitals NHS Trust, successfully applied for an NIHR Clinical Doctoral Research Fellowship to develop and deliver his study, Removing Erroneous Penicillin Allergy Labels (REPeAL).

He will investigate the best way to decide if patients can receive penicillin, and how to integrate this decision-making process into routine clinical practice.

Research has shown that patients with a penicillin allergy record are given less effective alternatives and do less well than patients without.

Around one in ten people have a penicillin allergy in their medical notes, but previous studies suggest nine out of 10 such patients are able to safely take the drug.

Possible reasons for being mis-labelled as allergic to penicillin include: experiencing a mild side effect, an intolerance rather than a true allergy; having grown out of an allergy; or incorrectly attributing a reaction to penicillin. 

This means a large number of patients are denied penicillin unnecessarily and put at risk of poorer outcomes.

Identifying all patients who could be safely ‘delabelled’ would require skin testing and allergy expertise, which not all hospitals have. REPeAL aims to develop and implement a structured set of questions to help clinicians decide whether or not to offer penicillin to those with an allergy recorded.

“Penicillin is generally well tolerated,” said Neil. “It’s effective and safe, therefore we want to be using it. In this study we are looking to identify the people who aren’t likely to have an allergic reaction and can be safely delabelled.

“There are lots of other reasons for conducting this study - for example, if you've got someone with a resistant bug and a penicillin allergy, their antibiotic options are limited. Also, a lot of the new antibiotics are based on penicillin.

“But the main reason is to optimise the use of penicillin and ensure as many people as possible are able to take it while in hospital.”

Higher-risk patients with a history of anaphylaxis are not currently included in the study, but “the aim is that we will be able to in future”.

Neil is studying how hospitals in other countries have tried to remove incorrect penicillin allergy records, including second-choice antibiotics, patient infection outcomes and any side effects.

He is also bringing in behavioural science experts to guide him in discussing patient concerns about being delabelled, and will monitor patients for any subsequent side effects.

REPeAL is currently running at RCHT, and the trust recently became the UK co-ordinating site for an international study looking at the impact of de-labelling on patient outcomes.