Closing the loop: a needs-assessment informed model for embedding a non-allergist penicillin allergy de-labelling service in acute medicine, a quality improvement report
In brief
Acute medicine teams removed penicillin allergy labels in 59 of 60 inpatients
In a quality improvement project at one UK hospital, acute medicine consultants and pharmacists removed penicillin allergy labels from 59 of 60 adult inpatients after a supervised amoxicillin challenge; one patient had a mild reaction, and none had anaphylaxis. All 21 patients who later needed antibiotics received penicillin without a reported reaction, but the single-site results need broader evaluation.
- Journal
- JAC-antimicrobial resistance (Q1)
- Published
- 5 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Philip Toner, Annabel Glass, Cathal Donnelly, Katherine Garnett, Mark Mchaffie, Sean Quinn, et al.
- PMID
- 42991575
- DOI
- 10.1093/jacamr/dlag244
Why clinicians should know about it
- Picked for Immunology and Allergy (paper of the day, 8 November 2026): Practical penicillin allergy delabelling with challenge safety outcomes
Abstract
OBJECTIVES: To describe and evaluate a needs-assessment informed model for embedding a non-allergist penicillin allergy de-labelling (PADL) service within an Acute Medical Unit (AMU), including stakeholder experience. METHODS: A four-phase quality improvement project in one UK AMU, reported per SQUIRE 2.0. Phase 1: needs-assessment survey of 124 staff (pharmacists, doctors, nurses, immunology staff). Phase 2: a multidisciplinary team translated Phase 1 barriers into a PEN-FAST-guided direct oral amoxicillin challenge (DOC) protocol delivered by acute medicine consultants and pharmacists; design decisions were retrospectively mapped to the capability, opportunity and motivation model for behavioural change and Behaviour Change Wheel. Phase 3: DOC in 60 adult inpatients penicillin allergy labels. Phase 4: post-implementation survey of 54 patients and staff. RESULTS: Before implementation, 90% of staff anticipated a service would be useful, but identified time, education, safety concerns and staffing as the main barriers. Fifty-nine of 60 patients (98.3%) were de-labelled, with one mild Type 4 reaction but no anaphylaxis. All 21 (35.6%) who needed antibiotics within six months received a penicillin without reported reaction. All 54 post-implementation respondents rated the service extremely useful and would recommend or refer into it; as Phase 1 and Phase 4 cohorts were non-matched, this comparison is indicative only. Patients described years of unwarranted anxiety about antibiotic use that resolved after de-labelling. CONCLUSIONS: A needs-assessment-informed model translated staff-identified barriers into design decisions and was associated with high stakeholder endorsement, durable penicillin use and an under-recognized psychological benefit for patients. It offers a practical, replicable template for non-allergist PADL in acute medicine.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.