Around 1 in 10 adults in the UK are estimated to be incorrectly labelled as penicillin-allergic. What if we could correct these labels, enabling more effective antibiotic use and reducing antibiotic resistance?
The ALABAMA trial, coordinated by Oxford’s Primary Care Clinical Trials Unit and published in The Lancet Primary Care, set out to answer that question.
Key Findings:
- Nearly 9 in 10 patients with a penicillin allergy label aren’t truly allergic.
- Removing false labels makes GPs 5 times more likely to prescribe first-line penicillin.
- Patients tested for allergy received fewer antibiotics overall.
- De-labelling reduces healthcare costs and helps curb antibiotic resistance
Around one in ten patients is currently labelled as allergic to penicillin, a figure that has significant implications for clinical care and public health. These labels often compel doctors to prescribe alternative antibiotics that are typically more expensive, less effective, and more likely to contribute to the growing problem of antibiotic resistance. In many cases, these alternatives also lead to longer illnesses and more complex treatment pathways.
The ALABAMA trial, led by the University of Leeds and Oxford's Primary Care Clinical Trials Unit, investigated the widespread mislabelling of penicillin allergies. Over 800 low-risk patients from 51 GP practices across England underwent allergy assessments followed by supervised penicillin challenges, 88% were found not to be truly allergic. This confirms that most penicillin allergy labels are inaccurate, leading to unnecessary use of less effective, more expensive antibiotics.
This innovative and timely study proves the principle that there are feasible, implementable ways of having people safely de-labelled as penicillin allergic, and that this means they are able to receive more appropriate care when they next get an infection. It's this kind of research question that has a huge impact on improving care for individuals, improving cost-effectiveness of what we do as clinicians, and helps us preserve the precious shared resource of antibiotics to all of us and to future generations.
De-labelling had significant clinical impact: GPs were five times more likely to prescribe penicillin, improving treatment effectiveness and reducing overall antibiotic use, key in combating resistance. Economically, the implications are clear. Penicillin is more affordable than alternative antibiotics, and widespread de-labelling could lead to substantial NHS savings.
This research shows that removing incorrect penicillin allergy labels has the potential to improve patient experiences, reduce health costs and tackle bacterial resistance. Now, we need to work together with policymakers and patients to help the NHS to address this issue.
Effective, national rollout requires more allergy specialists and streamlined protocols. Researchers are now working with NHS policymakers to make penicillin allergy testing a standard part of care.