Sustaining and spreading penicillin allergy de-labelling: a narrative review of the challenges for service delivery and patient safety

Research output: Contribution to journalReview articlepeer-review



Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm.

This review assesses an emergent evidence base and trend favouring de‐labelling using ‘direct’ oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these ‘direct’ de‐labelling strategies. There is a paucity of studies exploring the views and engagement of patients and health care professionals, and a gap in the evidence for pre‐requisites to safely deliver, sustain and spread the implementation of such services across health systems.


Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Early online date10 Dec 2019
Publication statusE-pub ahead of print - 10 Dec 2019


  • allergy, penicillin, patient safety, improvement science