# A nurse-run, pharmacist-led outpatient penicillin allergy de-label clinic in the UK

## TL;DR

A nurse-run outpatient clinic successfully removes incorrect penicillin allergy labels, improving patient safety and antimicrobial stewardship.

## Contribution

Demonstrates the safety and effectiveness of nurse-led penicillin allergy de-labelling in an outpatient setting.

## Key findings

- 115 low-risk patients underwent direct oral penicillin challenge, with 95.7% successfully de-labelled.
- Non-allergy nurses can safely perform penicillin allergy de-labelling in outpatient clinics.
- 39.9% of contacted patients had high-risk allergy histories, while 58.6% were categorized as low risk.

## Abstract

Penicillin allergy (penA) records are associated with negative patient and health-system outcomes, which makes removal of incorrect penA records (penicillin allergy de-labelling; PADL) an antimicrobial stewardship and patient safety priority. We set up a nurse-run, adult, low-risk PADL outpatient clinic, supervised by an antimicrobial pharmacist.

Adult PADL guidelines were written and approved by the hospital, and PADL training was provided to nurses. Electronic adult referrals from hospital outpatient clinics and three GP surgeries in Cornwall were accepted. Patient telephone triage started from 6 January 2025, which included taking a penA-focused history, penA risk assessment and determination of PADL method. Eligible patients were invited for a direct oral penicillin challenge (DOC) test and were followed up via a telephone call 10 days after the test. The first outpatient PADL clinic was on 7 February 2025.

There were 404 referrals between 27 December 2024 and 16 September 2025, of which 326 were successfully contacted. Of these, 130/326 (39.9%) had a high-risk penicillin allergy history and 5/326 (1.5%) were excluded due to cognitive impairment. Of the 326 contacts, 191 (58.6%) were categorized as low risk. Of these, 22/191 (11.5%) were de-labelled on history alone, 54/191 (28.3%) were awaiting their outpatient DOC appointment or declined attending clinic, and 115/191 (60.2%) attended clinic for DOC. Of 115 patients, 110 (95.7%) patients were successfully de-labelled and 5 (4.3%) retained their allergy status due to side effects.

PADL delivered by non-allergy nurses in the outpatient setting is safe and effective at removing low-risk penicillin allergy records.