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Most patients who test negative for penicillin allergy accept de-labelling, driven by prior doubts about their allergy, a sense of safety during testing, trust in healthcare providers, and clear post-test communication.
A new United Kingdom (UK)-based study from the ALABAMA trial reveals that most patients are open to having their penicillin allergy status removed following a negative allergy test—offering a promising step toward more accurate antibiotic prescribing in primary care.
Around 6% of patients in UK general practices are documented as having a penicillin allergy. However, less than 10% of these people are truly allergic, leading to widespread use of second-line antibiotics and reduced treatment effectiveness. The ALABAMA trial investigated whether a structured penicillin allergy assessment pathway (PAAP) could safely and effectively de-label those who are not truly allergic, and improve health outcomes. The qualitative arm of the ALABAMA trial explored how patients experienced the penicillin allergy testing process and whether they were willing to accept de-labelling after receiving a negative test result.
The research team executed semi-structured interviews with 28 patients who had participated in the PAAP intervention. Thematic analysis was employed for interpreting the data. Of the 28 patients interviewed, 26 tested negative for penicillin allergy. Among them, 24 agreed to be de-labelled and only 2 declined. Many patients already doubted their allergy prior to testing. Volunteers reported feeling safe, supported, and well cared for during the hospital-based penicillin allergy testing.
Trust in the testing process and clear communication following the results helped build confidence in accepting de-labelling. The majority of patients were receptive to penicillin allergy testing and willing to have their allergy records updated after a negative result. Key factors influencing acceptance included:
This study supports the rollout of structured allergy testing programmes in primary care and underscores the importance of patient-centered approaches to safely expand access to first-line antibiotics.
BJGP Open
Patients' acceptance of a penicillin allergy de-labelling programme in primary care
Marta Santillo et al.
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