A new study led by Monash University has shown how technology can be used by community pharmacists in identifying and addressing incorrect penicillin allergy labels, which is a key contributor to inappropriate antibiotic prescribing and antimicrobial resistance (AMR).
The study successfully trialled an algorithm for identifying incorrect penicillin allergy labels across 5 pharmacies in metropolitan Victoria over 7 weeks in 2024.
Of the 18,646 patients who presented to the pharmacies during this time, 163 had a penicillin allergy label, of which 18.4% were identified as having a Type A or non-immune mediated penicillin reaction history, meaning their reaction wasn’t triggered by the immune system.
The goal of the research team, led by Monash University’s Faculty of Pharmacy and Pharmaceutical Sciences (FPPS), was to provide pharmacists with a practical tool to help reclassify incorrect penicillin labels.
Sharmila Khumra, one of the study’s lead authors and Antimicrobial Stewardship pharmacist, explains that incorrect penicillin allergy labels significantly increases the risk of patients being prescribed less effective broad-spectrum antibiotics.
“When a patient is incorrectly labelled as penicillin-allergic they may get prescribed a broader-spectrum antibiotic, which has several drawbacks including AMR,” says Ms Khumra.
“While broad-spectrum antibiotics can be effective against a range of bacteria, their widespread use can lead to AMR, whereby bacteria becomes less susceptible to treatment.
“Addressing incorrect allergy labels provides prescribers and patients the opportunity to utilise first-line and appropriate antibiotics in lieu of second-line or inappropriate antibiotic choices.”
Elise Mitri, co-lead author and Drug Allergy and Immunology hospital pharmacist and PhD candidate at the Doherty Institute says standardised antibiotic allergy assessments are essential.
“The impact of antibiotic allergy labels is well documented in the Australian setting,” she says.
“Ensuring community pharmacists have the appropriate tools to offer a standardised antibiotic allergy assessment and identify patients with an incorrect allergy label is imperative.”
Dr Angelina Lim, FPPS academic and Deputy Course Director adds that teaching pharmacists to de-label incorrect allergies in the community is an important part of antimicrobial stewardship.
“Community pharmacists are well placed to provide penicillin allergy de-labelling support that will improve antibiotic prescribing for patients,” says Dr Lim.
“We recognise that community pharmacies are busy and having a simple algorithm to follow may help support them make interventions day to day.”
More than three-quarters (77%) of those with a Type A or non-immune mediated allergy label were receptive to education and de-labelling, while 23% were hesitant or non-receptive due to various reasons, including disbelief that their allergy label is incorrect.
The study, published in Infection, Disease and Health, concludes that the algorithm can support everyday community pharmacy practice and reduce the risk of incorrect antibiotic allergy labels in the community.
