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Barriers to paediatric penicillin allergy de-labelling in UK secondary care: a regional survey
  1. Kene Maduemem1,
  2. Hannah Clark2,
  3. Iseult Sohal3,
  4. Tom Dawson2,
  5. Niten Makwana4
  6. Paediatric Research Across the Midlands (PRAM) Network
    1. 1 Emergency department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
    2. 2 Paediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
    3. 3 Paediatrics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
    4. 4 Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
    1. Correspondence to Dr Kene Maduemem, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK; ebukakene{at}


    Background Incorrect penicillin allergy labels result in the use of inappropriately broad-spectrum antibiotics. De-labelling inaccurate penicillin allergy promotes antimicrobial stewardship and optimises prescribing practices. The objectives were to evaluate paediatric clinicians’ knowledge and understanding of penicillin allergy and to identify barriers in tackling incorrect penicillin allergy labels.

    Methods Paediatric clinicians from across the West Midlands of the UK were surveyed using an online, anonymised questionnaire between 1 August and 30 September 2021. Domains explored were (1) approach to penicillin allergy clinical vignettes, (2) knowledge of the impact of penicillin allergy labels, (3) frequency of allergy-focused history questions and (4) barriers in tackling incorrect penicillin allergy.

    Results Responses were received from 307 paediatric clinicians across 12 hospitals. Sixty-one per cent would not prescribe a penicillin-based antibiotic if a family history of penicillin allergy was reported. There was an overall deficit in taking an allergy-focused history with only 36.5% inquiring about diagnostic confirmation. Absence, or lack of awareness of a referral pathway for antibiotic allergy evaluation (58.6%) and unfamiliarity of the indications for oral provocation testing (55%) were the most common reported barriers to penicillin allergy de-labelling. Fifty-one per cent would rather ‘play it safe’ than explore penicillin allergy confirmation as it is felt that alternative treatments were readily available.

    Conclusions The deficiency in antibiotic allergy-focused history among paediatric clinicians highlights the need for better allergy education across all clinical grades. Pragmatic algorithms and clear referral pathways could address barriers faced by non-allergists in de-labelling incorrect penicillin allergy.

    • paediatrics
    • allergy and Immunology

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    • Twitter @KMaduemem

    • Collaborators Anandi Singh, Birmingham Community Healthcare NHS Trust; Hannah Cooper, Birmingham Women’s and Children’s NHS Trust; Amanda Thompson, Walsall Healthcare NHS Trust; Sieu Ha, The Dudley Group NHS Foundation Trust; Amy Clarkson, Shrewsbury and Telford Hospital NHS Trust; Hema Kannappan, University Hospitals of Coventry and Warwickshire NHS Trust; Poonam Kumar, South Warwickshire NHS Foundation Trust; Laura Draper, University Hospitals of Coventry and Warwickshire NHS Trust; Ezgi Seager, New Cross Hospital Wolverhampton NHS Trust; Emma Brazier, University Hospitals Birmingham NHS Foundation Trust; Chibuko Ukeje, Sandwell and West Birmingham Hospitals NHS Trust; Giedre Kayello, Sandwell and West Birmingham Hospitals NHS Trust.

    • Contributors Study conception—KM and NM. Design of the study—all authors. Acquisition, analysis and interpretation of data—all authors through PRAM collaborators. Drafting of the manuscript—KM. Critical revision of the manuscript for important intellectual content—HC, TD and NM. Final approval of submitted version—all authors. Guarantor-NM

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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