Nearly nine in ten people with a penicillin allergy label on their medical records are not truly allergic and could have the label safely removed, a major clinical trial has found. The finding could lead to patients receiving more effective, first-choice antibiotics, improve their recovery from infection, and is a vital step in the fight against antimicrobial resistance.
The ALABAMA trial, led by the University of Leeds and published today in The Lancet Primary Care, involved more than 800 patients from GP practices across England. It was coordinated by our department's Primary Care Clinical Trials Unit, which specialises in running large-scale, complex studies to answer questions that are critical for the NHS.
The research addresses a major public health issue. More than one in 15 UK adults has a penicillin allergy label, often forcing clinicians to use alternative 'second-line' antibiotics. These can be less effective, have more side effects, or contribute to the rise of drug-resistant infections.
The trial found that when a false allergy label was removed, GPs were five times more likely to prescribe penicillin, and patients who had the allergy check received fewer antibiotics overall.
Co-author Chris Butler, Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences, said: "This innovative and timely study proves the principle that there are feasible, implementable ways of having people safely delabelled 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.”
A personal legacy drives research impact
The research has particular poignancy for joint lead author Professor Sue Pavitt from the University of Leeds, whose mother Rosie died of an antimicrobial resistant infection after carrying a penicillin allergy label for 65 years – a label that may never have been accurate.
Rosie had been labelled allergic in 1956 after developing a rash while taking penicillin for mastitis. She avoided the antibiotic for the rest of her life, often needing multiple courses of less effective alternatives when infections struck. She died at 91 from an infection that couldn't be controlled by antibiotics.
As a patient public contributor to the ALABAMA trial, Rosie helped ensure the research was accessible to older people with multiple health conditions – a group often excluded from clinical trials but particularly important to reach.
Next steps for the NHS
While the findings show penicillin allergy testing is cost-effective, implementing it across the NHS faces challenges due to a limited number of allergy specialists. The research team is now working with NHS colleagues to plan how to widen access to this vital assessment.
Dr Jonathan Sandoe, joint lead author from the University of Leeds, said: "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."
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