Implementation of a proposed algorithm to de-labelling penicillin allergy in community pharmacy

Introduction. A false allergy/type A allergy labelled as a true penicillin allergy can lead to unnecessary avoidance of penicillins, often resulting in using less effective and broader-spectrum antibiotics. Community pharmacists have a pivotal role to play in de-labelling false allergies or preventing false allergy labels from occurring.

Aims. To investigate the number of opportunities to de-label type A allergies in community pharmacies across Victoria via implementation of an algorithm based on a hospital validated beta lactam antibiotic allergy assessment tool.

Methods. A quasi-experimental study. Six community pharmacies were included and patients were recruited daily for 7 weeks between April – May 2024. All patients presenting to the community pharmacy dispensary were asked about allergies and management followed a proposed algorithm for allergy management. De-labelling outcomes were recorded. Facilitators and challenges to implementing the service were also collected through semi-structured interviews.

Results. Over 3500 patients were seen in the 7-week period with 24.3% of patients reported a false type A allergy. All patients presenting with Type A allergies were attempted to be de-labelled. Of those who were attempted to be de-labelled, 81.8% reported acknowledgement of the non-true allergy. Those who were not receptive mainly claimed using the label to protect them using a penicillin that cause them side effects. Older patient groups and patients who have been discharged recently from hospital were hardest to de-label. There is still a public misconception that there is an endless supply of different types of antibiotics, and the public is largely unaware of how allergy labels impact antimicrobial resistance.

Discussion. The proposed algorithm for management of penicillin allergies was easily implemented across community pharmacies to guide de-labelling and allergy education and can be a useful tool for future practice. Upskilling pharmacists to manage penicillin allergy can help improve the public misconceptions and reduce risk of antimicrobial resistance.