Elise Mitri1,2,3,4, Shanti Narayanasamy1,5,6, Natasha E Holmes1,3, Courtney Ierano3,7, Jason Roberts8,9, Suran Fernando10,11, Jason A Trubiano1,3,4
1Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Victoria, Australia, 2Department of Pharmacy, Austin Health, Victoria, Australia, 3Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia, 4National Allergy Centre of Excellence (NACE), hosted by the Murdoch Children’s Research Institute, Parkville, VIC, Australia, 5Duke Global Health Institute, Durham, NC, USA, 6Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, USA, 7National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Victoria, Australia, 8University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia, 9Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia, 10Department of Clinical Immunology and Allergy, Royal North Shore Hospital, NSW, Australia, 11Faculty of Medicine and Health, University of Sydney, NSW, Australia
Abstract:
Rationale
Penicillin allergy confers significant patient and health service burden, however a gap exists in meeting the demand for penicillin allergy delabelling services in Australian hospitals. This study aimed to evaluate current penicillin allergy delabelling activity performed by multi-disciplinary Australian clinicians and assess attitudes and barriers to non-allergist led penicillin allergy delabelling.
Methods
From 19th May – 1st July 2023, a cross-sectional survey was distributed to Australian medical practitioners, nurses/nurse practitioners and pharmacists via relevant professional organisations and to attendees at an Australian Drug Hypersensitivity Symposium (Melbourne, Victoria).
Results
157 clinicians participated in the survey; 17 (11%) allergists, 76 (48%) non-allergist medical practitioners, 49 (31%) pharmacists and 15 (10%) nurses. Most participants (126/149, 85%) reported performing penicillin allergy assessment and delabelling; 92 (62%) perform direct oral challenge (DOC). Most participants (140/146, 96%) believed inpatient DOC for low-risk penicillin allergy should be performed. Participants identified education and training, scope of practice, staff resources, time constraints and safety concerns as the consistent barriers to non-allergist led inpatient penicillin DOC. The majority of participants strongly agreed (98/142, 69%), or agreed (90/142, 63%), that following appropriate training, nurses/nurse practitioners and pharmacists respectively, can independently undertake penicillin DOC in appropriately assessed low-risk patients.
Conclusion
Addressing barriers to non-allergist led inpatient low-risk penicillin allergy delabelling through development of structured penicillin allergy delabelling programs and engagement of health service support may improve equity of access to penicillin allergy delabelling, and optimise antimicrobial prescribing, particularly in areas where Allergy and Immunology services are limited.