Getting the label right – are you really allergic to penicillin?

Antibiotic Guardianship Awards. Shared Learning 2025 - Prescribing and Stewardship

Project Overview

Approximately 10% of people are labelled as penicillin allergic, although most have not experienced an allergic reaction. Incorrect penicillin allergy labels can lead to suboptimal antibiotic treatment, worsening patient outcomes.

The Cardiff and Vale Penicillin Allergy De-Labelling (PADL) group developed a screening protocol and challenge test to remove unconfirmed penicillin allergy labels from hospital inpatients. Piloted at two hospitals within Cardiff and Vale University Health Board (CAVUHB), patients with non-allergic intolerance were de-labelled automatically, while those with low-risk allergic histories underwent an oral amoxicillin challenge test. They were observed for one hour, followed by a five-day follow-up. Of the 167 patients assessed, 95 were de-labelled – 33 based on history and 62 after the challenge.

Due to the pilot’s success, the CAVUHB PADL group collaborated with the All Wales Therapeutics and Toxicology Centre (AWTTC) to create All Wales guidance for penicillin allergy de-labelling in adults in secondary care, tailored for non-allergy specialists. We have developed a comprehensive national resource that includes a risk algorithm, patient information leaflets, consent forms, post-test information for patients (both negative and positive result), advice for managing allergic reactions and standard letters for patients and GPs to communicate negative or positive test result. The toolkit also features a template for alert cards for patients with confirmed penicillin allergies and easy-read leaflets developed in partnership with Learning Disability Wales.

The project underwent an open consultation during its development. The draft was made publicly available on the AWTTC website and shared with key stakeholders, including Public Health Wales. In response to the feedback received, the guidance was revised, and reviewed by the All Wales Prescribing Advisory Group, before being endorsed by All Wales Medicines Strategy Group (AWMSG) in May 2024. The project was published on AWMSG/AWTTC website in July 2024, accompanied by an Equality and Health Impact Assessment.