Observational studyThe Journal of infection2024
A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling 'low risk' patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems.
Observational study in The Journal of infection, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Pooled it
- The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial.The journal of allergy and clinical immunology. In practice · 2025Trial
- Infection-embedded penicillin allergy de-labelling delivers immediate antimicrobial stewardship gains in patients with active infection.JAC-antimicrobial resistance · 2026Article
- Penicillin allergy delabeling in a German University Hospital-implementation in inpatient settings: the PenGuin Pilot Study.Infection · 2026Article
- The prevalence and risk factors of drug allergy in Sri Lanka-a multi-centre cross-sectional observational study (2024-2025).The Lancet regional health. Southeast Asia · 2026Article
- Amoxicillin Direct Oral Challenge in Hospitalized Patients With High-Risk Allergic Reactions, in a Pharmacist-Directed Program.Open forum infectious diseases · 2026Article
- Widening access to penicillin allergy assessment in the United Kingdom-a proposed implementation plan for the National Health Service (NHS).JAC-antimicrobial resistance · 2026Review
- Charting new territory: outpatient stewardship in immunocompromised patients (first of a two-part series).Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- An Economic Evaluation of Direct Oral Penicillin Challenge for De-Labelling Low Risk Patients With a Penicillin Allergy Label.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Article
- Rationalizing antibiotic prescribing for bacterial pneumonia in patients with reported penicillin allergy-a qualitative study.JAC-antimicrobial resistance · 2025Article
- Penicillin allergy delabeling in long-term care facilities: if not now, then when?Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Patient-related factors impact the implementation of inpatient antibiotic allergy delabeling.The journal of allergy and clinical immunology. Global · 2024Article
- Factors influencing implementation and adoption of direct oral penicillin challenge for allergy delabelling: a qualitative evaluation.BMJ open quality · 2024Article
- Narrative review of recent developments and the future of penicillin allergy de-labelling by non-allergists.npj antimicrobials and resistance · 2024Review
- Penicillin allergy de-labelling by non-allergy specialists in the elective surgical setting: A mixed-methods systematic review protocol.Anaesthesia reportsReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
21 authors at 9 institutions in 2 countries.
Funding
Abstract
objectiveThe huge burden of inaccurate penicillin allergy labels (PALs) is an important driver of antimicrobial resistance. This is magnified by insufficient allergy specialists and lack of 'point-of-care' tests. We investigated the feasibility of non-allergy healthcare professionals (HCPs) delivering direct oral penicillin challenges (DPCs) for penicillin allergy de-labelling.
methodsThis prospective observational study was conducted in three hospitals in England across three settings (acute medical, pre-surgical and haematology-oncology). Patients with a PAL were screened and stratified as low risk/high risk. Low risk patients (non-immune mediated symptoms, benign rash, tolerated amoxicillin since and family history) underwent a DPC.
resultsN = 2257 PALs were screened, 1054 were eligible; 643 were approached, 373 declined, 270 consented and 259 risk stratified (low risk = 155; high risk = 104). One hundred and twenty-six low risk patients underwent DPC, 122 (96.8%) were de-labelled with no serious allergic reactions. Conversion rate from screening-to-consent was 12% [3.3% and 17.9% in acute and elective settings respectively; odds ratios for consent were 3.42 (p < 0.001) and 5.53 (p < 0.001) in haematology-oncology and pre-surgical setting respectively. Common reasons for failure to progress in the study included difficulty in reaching patients, clinical instability/medical reasons, lacking capacity to consent and psychological factors.
interpretationDPCs can be delivered by non-allergy HCPs. A high proportion of patients with PALs did not progress in the study pathway. Strategies to deliver DPC at optimal points of the care pathway are needed to enhance uptake. Elective settings offer greater opportunities than acute settings for DPC. The safety and simplicity of DPCs lends itself to adoption by healthcare systems beyond the UK, including in resource-limited settings.
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