D3.395 - Evaluation for suspected penicillin allergy - the patient perspective

Penicillin allergy is often overreported, with up to 10% prevalence in affluent countries. Of these, 90% can be de-labeled following allergy evaluations, including drug provocation tests. Carrying a penicillin allergy label can lead to negative consequences, including the use of broad-spectrum antibiotics which might be less effective and increase the risk of antimicrobial resistance.

Understanding the patients' perspectives and concerns is crucial for improving the efficiency of de-labeling and ensuring patient compliance with taking medications when indicated after de-labeling. The aim of this study was to explore the patients' experiences of being evaluated for a suspected penicillin allergy. 

Consecutive patients referred for allergy investigation were asked to participate and were risk-stratified by an allergist. Regardless of allergy risk or results of subsequent evaluations, 15 consenting individuals were included and participated in semi-structured interviews. Content analysis by Graneheim and Lundman was conducted.

Three themes emerged from the analysis: 1) poor understanding and documentation of penicillin allergy by healthcare professionals before evaluation, 2) expectations and feelings regarding drug provocation, and 3) willingness to accept penicillin after de-labeling.  Several participants described that penicillin was prescribed despite the allergy label or reported penicillin allergy. Patients therefore felt responsible for informing caregivers about their suspected or confirmed allergies, giving rise to anxiety. Delayed reactions were often misinterpreted as non-allergic side effects. In several cases participants were referred to an allergist many years after the initial reaction. They described lack of awareness of the detrimental consequences of penicillin allergy labeling and that labels may be incorrect. There was a willingness to accept penicillin following a negative provocation, although several preferred to receive the initial course in a location with advanced healthcare infrastructure due to anxiety related to previous negative experiences. 

Improved and comprehensive guidelines for the management of suspected penicillin allergy are necessary to enhance understanding of penicillin allergy and ensure that patients are promptly evaluated after a suspected allergic reaction with referral to an allergist if indicated. Correct documentation before, as well as after drug allergy evaluation is essential for patient safety in future care.