• NB: This should only be done on patients with PENFAST scores of 0-2.
• Discuss de-labelling with patient/Power of Attorney (PoA); document the consent in patient’s notes.
• A patient information leaflet is available for use here.

 

Pre challenge checks

• Ensure no contraindications (as per flowchart)
• Discuss with patient’s senior clinician
• Ensure nursing staff are aware of challenge, and can undertake the monitoring required
• Patients taking antihistamines should pause these for 24h prior to challenge, where safe to do so.

 

Oral challenge protocol

NB: If the original reaction was to flucloxacillin, then this can be used as the challenge drug (500mg stat) instead of amoxicillin.

 

Documenting Outcome of Penicillin Challenge and De-labelling

Modify allergy status on Secondary care/Primary care notes

• If allergy disproven, state “Successfully delabelled DD/MM/YYYY: Patient is NOT penicillin-allergic”
• If allergy confirmed, state “Penicillin allergy CONFIRMED on DD/MM/YYYY– symptoms of XXX”

Also modify the allergy status on Clinical Portal and HEPMA.

Inform the patient the outcome of the challenge. If the allergy has been disproved then counsel the patient that they are no longer allergic to penicillins.

Make a note of the outcome on the patient’s discharge letter.

Clear documentation is important as patients who have been successfully de-labelled are commonly “re-labelled” on a subsequent admission

 

 

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