Characteristics, risk factors and clinical impact of penicillin and other antibiotic allergies in adults in the UK General Practice: a population-based cohort study

Yogini Jani; Boqing Chen; Neil Powell; Philip Howard; Jonathan Sandoe; Rob West; Wallis Cy Lau

doi:10.1016/j.jinf.2024.106367

Characteristics, risk factors and clinical impact of penicillin and other antibiotic allergies in adults in the UK General Practice: a population-based cohort study

J Infect. 2025 Jan 3:106367. doi: 10.1016/j.jinf.2024.106367. Online ahead of print.

Authors

Yogini Jani¹, Boqing Chen², Neil Powell³, Philip Howard⁴, Jonathan Sandoe⁵, Rob West⁶, Wallis Cy Lau⁷

Affiliations

¹ Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom. Electronic address: y.jani@ucl.ac.uk.
² Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
³ Pharmacy Department, Royal Cornwall Hospital Trust, Truro, Cornwall, TR1 3LJ.
⁴ AMR Prescribing Team, NHS England, Newcastle, United Kingdom; School of Healthcare, University of Leeds, Leeds, United Kingdom.
⁵ Healthcare Associated Infection Group, Leeds Institute of Medical research, University of Leeds; Department of Microbiology, Leeds Teaching Hospitals NHS Trust.
⁶ Leeds Institute of Health Sciences, University of Leeds.
⁷ Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong.

PMID: 39756694
DOI: 10.1016/j.jinf.2024.106367

Abstract

Objective: To assess the characteristics, risk factors and clinical impact of penicillin and other antibiotic allergies labels in general practice in the UK.

Design: Population-based cohort study.

Setting: Primary care in the UK, 2000-2018.

Participants: Adults aged 18-100 years who were registered with their general practice for at least 12 months between 01-Jan-2000 and 31-Dec-2018 and followed until 25-Sep-2019.

Main outcome measures: The main outcomes include the annual prevalence and incidence of penicillin and other antibiotic allergies labels. Multinominal logistic regression was used to examine the characteristics associated with receiving an allergy label to different antibiotics. Cox regression modelling was used to compare the risk of resistant infections (methicillin resistant Staphylococcus aureus [MRSA] and vancomycin resistant enterococci) as well as Clostridioides difficile (C.difficile) infection between patients with and without allergy labels. The monthly proportion of patients who had a penicillin allergy test, either before their allergy label was recorded or within one year, was calculated to assess any impact of NICE penicillin allergy assessment recommendations (Clinical guideline [CG183]) in September 2014.

Results: Both the prevalence and incidence of penicillin allergy label showed a pattern of initial growth followed by a decline. The prevalence reached a maximum of 8.25% in 2011, and the incidence peaked at 0.46% in 2004. Older age, being female, living in less deprived areas, belonging to a larger general practice, and having co-morbidities were associated with a higher chance of receiving a penicillin or other antibiotic allergy label. Patients with antibiotic allergy labels were more likely to receive alternative broad-spectrum antibiotics and had a higher risk of MRSA and C.difficile infections. The introduction of NICE drug allergy guideline did not alter the proportion of patients undergoing penicillin allergy assessment.

Conclusion: Penicillin and other antibiotic allergy labels are common and lead to radical change in the antibiotic prescribing practices and are associated with resistant and healthcare associated infections.

Keywords: Antimicrobial stewardship; Penicillin allergy.