P30 Can non-allergy health workers safely delabel reported penicillin allergies using an antibiotic allergy assessment tool? - A multicentre study

Background False penicillin allergy labels can be potentially hazardous to patients. Most penicillin allergy labels can be safely removed following risk stratification and formal drug challenge. These de-labelling strategies have been limited to specialist allergy and infectious disease services. Aims To determine whether non-allergy specialist health-care workers can use an antibiotic allergy assessment tool (AAAT) to correctly phenotype and manage reported penicillin allergy. Method Non-allergy health-care workers in three UK hospital were emailed online questionnaires and asked to assign the allergy phenotype and management recommendation for eight vignettes of real cases reporting a penicillin allergy using the AAAT. In one hospital participants were randomised into two groups: one group was directed to use the AAAT whilst the second group had no decision tool. Participants were assigned an average score for correct allergy phenotype, management and a major error rate. Results Use of the AAAT across the eight vignettes significantly improved the average score for assigning correct phenotype (6.7 vs 5.2 p < 0.001), management choice (7.1 vs 5.7 p < 0.001), and major error rate (0.6 vs 1.6 p < 0.001). Participant performance with the AAAT was generalizable across all three hospitals. Despite use of the AAAT 35-40% of participants made at least one major error. Conclusion The AAAT significantly improved health worker performance in phenotyping and choosing correct management for reported penicillin. However, even with the AAAT, there remains a risk of potentially hazardous management choices highlighting the need for formal allergy training to expand penicillin allergy assessment services.