Non-allergist inpatient penicillin allergy de-labelling (RIPAL)
Research type
Research Study
Full title
Non-allergist inpatient penicillin allergy de-labelling
IRAS ID
299708
Contact name
Neil Powell
Contact email
Sponsor organisation
Royal Cornwall Hospital NHS Trust
Duration of Study in the UK
0 years, 3 months, 4 days
Research summary
Penicillin antibiotics are first-line treatment for many common infections. Approximately 15% of inpatients are reported to have a penicillin allergy label precluding the use of penicillin in favour of second line antibiotic agents. This use of non-penicillin antibiotics is associated with exposure to a greater number of antibiotics, increased length of hospital stay, higher hospital readmission rates, increasing the cost of care. In addition, non-penicillin based antibiotics are often more costly, can be less effective in certain clinical circumstances, and are more toxic, and often broader spectrum potentially increasing patient’s risk of future infections with resistant bacteria.
More than ninety per cent of individuals with a penicillin allergy label can tolerate penicillin. Identifying and de-labelling patients who are not allergic to penicillin has the potential to reduce second line antibiotic use in favour of penicillin, thus reducing these associated unintended consequences associated with second line antibiotics.
Historically penicillin allergy testing has been done by allergists using penicillin skin testing prior to the definitive drug provocation test. More recently, drug provocation tests, without preceding skin testing, has been shown to be a safe de-labelling method for inpatients with a low-risk allergy history, and has been done by non-allergists, including pharmacists in several countries but none in UK inpatients.
The requirements of a penicillin allergy de-labelling intervention delivered, by non-allergists have been described by several allergy experts. This study has taken these recommendations and used them to develop an inpatient, non-allergist delivered, penicillin allergy de-labelling intervention that sets out to risk stratify patients and offer those with a low-risk penicillin allergy history, and on second line antibiotics, an amoxicillin test dose to demonstrate penicillin tolerability and to change the patient’s current antibiotic therapy to first line therapy.REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
22/YH/0087
Date of REC Opinion
16 Jun 2022
REC opinion
Further Information Favourable Opinion