Savic, L, Thomas, C, Fallaha, D et al. (5 more authors) (2020) DALES, Drug Allergy Labels in Elective Surgical patients: a prospective multicentre cross-sectional study of incidence, risks, and attitudes in penicillin de-labelling strategies. British Journal of Anaesthesia, 125 (6). pp. 962-969. ISSN 0007-0912
Abstract
Background
Penicillin allergy is associated with a range of poor health outcomes. Allergy testing can be made simpler by using a direct drug provocation test in patients at low risk of genuine allergy. This approach could allow population-level ‘de-labelling’. We sought to determine the incidence and nature of penicillin allergy labels in UK surgical patients and define patient and anaesthetist attitudes towards penicillin allergy testing.
Methods
A prospective cross-sectional questionnaire study was performed in 213 UK hospitals. ‘Penicillin allergic’ patients were interviewed and risk-stratified. Knowledge and attitudes around penicillin allergy were defined in patients and anaesthetists.
Results
Of 21 219 patients, 12% (n=2626) self-reported penicillin allergy; 27% reported low-risk histories potentially suitable for a direct drug provocation test; an additional 40% reported symptoms potentially suitable for a direct drug provocation test after more detailed assessment. Of 4798 anaesthetists, 40% claimed to administer penicillin routinely when they judged the label low risk. Only 47% of anaesthetists would be happy to administer penicillin to a patient previously de-labelled by an allergy specialist using a direct drug provocation test; perceived lack of support was the most common reason for not doing so.
Conclusions
At least 27% of patients with a penicillin allergy label may be suitable for a direct drug provocation test. Anaesthetists demonstrated potentially unsafe prescribing in patients with penicillin allergy labels. More than half of anaesthetists lack confidence in the results of a direct drug provocation tests undertaken by a specialist. Our findings highlight significant barriers to the effective implementation of widespread de-labelling in surgical patients.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Keywords: | allergy; allergy testing; anaesthesia; de-labelling; drug provocation test; patient safety; penicillin |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Inflammatory Arthritis (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Sep 2020 14:22 |
Last Modified: | 06 Sep 2024 15:45 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.bja.2020.07.048 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:165158 |