Cornish pharmacist leads research to address problem of incorrect penicillin allergy labelling

In an innovative stride towards improving patient outcomes, Neil Powell, a clinical pharmacist based in Cornwall, has spearheaded a crucial research project aimed at rectifying the widespread issue of incorrect penicillin allergy labels.

Funded by the National Institute for Health and Care Research (NIHR), the Removing Erroneous Penicillin Allergy Labels (REPeAL) study emerges as a beacon of hope for enhancing antibiotic treatment efficiency.

Addressing a Common Misconception

A staggering one in ten individuals has a penicillin allergy noted in their medical records; however, research indicates that up to 90% of these patients can safely take the medication. Mislabelling can arise from various factors, including mild intolerances mistaken for allergies, outgrown allergies, or misattributed reactions. This incorrect categorisation severely limits effective treatment options, propelling Neil and his team at the Royal Cornwall Hospitals NHS Trust to action.

The REPeAL Strategy

REPeAL’s objective is crystal clear: to devise a methodical approach for clinicians to accurately assess penicillin allergy claims and incorporate these evaluations seamlessly into routine care practices. The project proposes a structured questionnaire coupled with a decision support tool, enabling healthcare professionals to make informed decisions about penicillin administration.

Enhancing Clinical Practices

Neil, serving as a Consultant Antimicrobial Pharmacist, elucidates the significance of penicillin in medical treatment – its broad tolerance, effectiveness, and safety profile make it an indispensable resource in combating infections. The REPeAL study not only aims to reaffirm penicillin’s utility but also to extend its benefits to a wider patient demographic, particularly those erroneously labelled as allergic.

Overcoming Challenges

The study recognises the complexity of accurately identifying patients who can be safely ‘delabelled’. For those with a history of mild intolerance or low-risk symptoms, healthcare practitioners possess the requisite skills for reassessment. Yet, this is not routinely practiced. REPeAL aspires to transform this by empowering clinicians with the tools to confidently offer penicillin where feasible, significantly improving patient care and antibiotic stewardship.

Patient-Centric Approach

Approximately half of the patients with a penicillin allergy on their record present a low-risk history. Neil’s approach involves directly addressing these misconceptions, providing clear explanations and, in some instances, administering an oral penicillin dose to demonstrate non-allergic status. The project, however, treads cautiously with high-risk patients, excluding those with a history of severe allergic reactions such as anaphylaxis from the delabelling process initially.

Beyond Delabelling

REPeAL is not limited to the practical aspects of delabelling; it is also an academic endeavour. Neil is delving into medical literature to gauge international experiences with incorrect penicillin allergy records, aiming to assess the broader implications on antibiotic usage, patient outcomes, and potential side effects. Furthermore, the inclusion of behavioural science experts underscores the study’s holistic approach, ensuring that patient concerns are meticulously addressed and the delabelling process is both transparent and reassuring.

A Global Perspective

Under Neil’s guidance, the Royal Cornwall Hospitals NHS Trust now stands as the UK co-ordinating site for iNAAN, an international study examining the impact of delabelling on patient outcomes. This collaboration underscores the global significance of addressing incorrect penicillin allergy labels and the potential for widespread positive change in healthcare practices.

Forging Ahead

The REPeAL study represents a significant leap forward in optimising antibiotic use and enhancing patient care. By addressing the issue of incorrect penicillin allergy labels, Neil and his team are setting a new standard in clinical practice, with the promise of more effective, safe, and personalised treatment options for patients across the UK and beyond.

For additional information on the NIHR Fellowship programme and its initiatives, interested parties are encouraged to visit NIHR’s official website.