Manas Dave examines topics covered in our sister journal Evidence-Based Dentistry

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‘Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labelling' was published in the Journal of the American Dental Association1 in May 2024 and ‘How can we remove erroneous penicillin allergy labels?' was published in Evidence-Based Dentistry in January 2025.2

Background

Patient reported penicillin allergies remain largely unquestioned.3 Many patients will self-report an allergy to penicillin for reasons such as:

  1. 1.

    Common antibiotic side effects such as nausea or diarrhoea

  2. 2.

    Symptoms of the treating infection being confused as side effects of the antibiotic

  3. 3.

    A childhood reported allergy where the patient has no memory of the symptoms but has always been told.

Studies have estimated 10% of patients self-report as being allergic to penicillin but less than 1% are actually allergic.1 Other studies have also reported that 95% of patients labelled as penicillin allergic will have a negative penicillin allergy test and tolerate exposure to penicillin.3 Unverified penicillin allergy is being recognised as a public health concern because of the unnecessary increased use of alternative antibiotics, increased costs and poorer patient outcomes.3

Dentists are responsible for approximately 10% of all antibiotic prescriptions worldwide,4 hence are strategically positioned to initiate discussions with patients on penicillin allergy reassessment.

Methods

The aim of this study was to develop the Penicillin Allergy Reassessment for Treatment Improvement (PARTI) tool that was designed to facilitate the re-evaluation of documented penicillin allergies with subsequent referrals for allergy testing as needed. This was done through a mixed-methods approach using patient focus groups and healthcare worker questionnaires.

Results

  • In total, 15 patients engaged in focus groups and 50 healthcare workers responded to the questionnaire in the United States of America

  • 86.6% of participants reported being asked about drug allergies however only 33.3% received follow-up questions about this such as timing of the reaction and symptoms. When participants provided information on their own about penicillin reactions, 40% mentioned a skin reaction during childhood, 13.3% mentioned a skin reaction as an adult and 46.7% could not recall specific symptoms but were told they had a reaction in the past

  • Feedback was provided on the PARTI tool which was updated and is available to freely download online: https://www.myads.org/assets/docs/resources/antibiotic-stewardship/Penicillin%20Allergy%20Reassesment%20for%20Treatment%20Improvement%20%28PARTI%29%20Tool.pdf.

    This study highlights the importance of a structured approach towards understanding patient self-reported allergy status.

Conclusions

The authors stated:

‘…the PARTI tool can help bridge the communication gaps between patients and dentists and the rest of the health care team regarding PCN [Penicillin] allergies and appropriate PCN allergy labels in patient medical records…'.

Commentary

Accurate antibiotic allergy reporting is an area of research need that brings the limitations of self-reported penicillin allergy to attention. This mixed methods study was well conducted however there were some limitations such as the lack of a pilot, no scoring tool and limited sample sizes. Overall, this study highlights the importance of a structured approach towards understanding patient self-reported allergy status.