Patients’ acceptance of a penicillin allergy de-labelling programme in primary care: a qualitative study

Background

About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these people are likely to be truly allergic. Consequently, a significant portion of the population is denied first line antibiotics. The ALABAMA trial aimed to determine if a penicillin allergy assessment pathway (PAAP) was safe and effective in de-labelling patients as allergic and improving antibiotic prescribing and patient health outcomes.

Aims

To investigate patients’ experience of penicillin allergy testing (PAT) and their acceptance of de-labelling following a negative allergy test.

Design & setting

This was a qualitative study using semi-structured interviews with patients who took part in the PAAP intervention arm of the ALABAMA trial.

Method

As part of a mixed-methods process evaluation embedded in the ALABAMA trial, we conducted interviews with patients in the PAAP intervention arm. Data from interviews with patients was analysed using thematic analysis.

Results

Of the 28 participants interviewed, two received a positive PAT result and 26 received a negative PAT result; of these, 24 accepted and two declined de-labelling. At point of trial recruitment, many patients already doubted that they were allergic to penicillin. Patients were happy to attend PAT and felt cared for and safe at the hospital. These factors led to most people trusting their negative test result and accepting de-labelling.

Conclusion

The patients we interviewed engaged with the PAAP intervention and, when testing negative, were predominantly willing to have their allergy record changed and to take penicillin in future. We highlight factors which influenced patients’ acceptance of de-labelling to facilitate future adoption of PAAP. These factors, which we should consider when planning for penicillin allergy testing services, were: patients identifying themselves as low risk before the test, PAT being perceived as trustful and safe, patients previous experience of penicillin allergy and reactions, patients understanding of penicillin reactions and clear communication after de-labelling.