Implementation of a proposed algorithm to assess and de-label false penicillin allergy labels in the community

BACKGROUND: Community pharmacists could have a pivotal role to play in de-labelling false penicillin allergies or preventing false penicillin allergy labels from occurring to reduce inappropriate prescribing of less effective and broader-spectrum antibiotics. METHODS: A quasi-experimental study aimed at implementing and evaluating an algorithm to assess and de-label false penicillin allergy labels in the community. Between April and May 2024, the algorithm was rolled out to five community pharmacies in Victoria, Australia. De-labelling outcomes of Type A reactions were recorded. Barriers and enablers to implementing the penicillin allergy assessment algorithm were also collected through semi-structured interviews. RESULTS: Of 18,646 patients who presented to the pharmacies, 163 individuals (0.87 %) had a penicillin allergy label. Of these 163 patients, 30 (18.4 %) patients were assessed as having a Type A reaction (a non true allergy; non-immune related). All patients with Type A reactions were engaged in an attempt to de-label their allergy; 77 % of patients were accepting whilst 23 % were hesitant or non-receptive, due to time restraints or disbelief that their allergy is not a true allergy. Qualitative interview data revealed there remains a public misconception that antibiotic allergy labels do not impact the appropriateness of antibiotic prescribing or affect patient safety through increased risk of adverse drug events and antimicrobial resistance. CONCLUSIONS: The proposed algorithm was able to support the de-labelleling of false penicillin allergies. Future research could implement the use of the algorithm in other primary care settings and ascertain the long-term retention of the initiation of de-labelleling in the community.