ArticleClinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology2025
An Economic Evaluation of Direct Oral Penicillin Challenge for De-Labelling Low Risk Patients With a Penicillin Allergy Label.
Article in Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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.
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Who cites it
2 citing papers in PubMed.
- Delabeling penicillin allergies in plastic and reconstructive surgery: Cefazolin as the cornerstone for antibiotic prophylaxis.JPRAS open · 2026Review
- Outcomes of a penicillin allergy de-labelling implementation intervention in a UK hospital: a prospective, single centre, type 2 hybrid effectiveness-implementation study evaluated using mixed methods.Implementation science communications · 2026Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundRemoving inaccurate penicillin allergy labels (PALs) can reduce unnecessary exposure to 'watch' and 'reserve' groups of antibiotics and thereby reduce antimicrobial resistance. The most efficient model for a non-allergy-specialist-led penicillin allergy de-labelling (PADL) service has not been established.
objectiveTo determine the costs to the UK National Health Service of a direct oral penicillin challenge (DPC) for low-risk patients with a PAL in three hospitals in England, each with a different non-allergy-specialist delivery model: pharmacist-led, nurse-led, and mixed multidisciplinary.
methodsCost analysis of the DPC pathway, including resources related to staff time and antibiotics. The effect of de-labelling on healthcare utilisation over 5 years was modelled using data from the published literature.
resultsIn total, 2257 patients from the Acute Medical or Infectious Disease Unit (AMU/IDU), Pre-surgical, and Haematology-Oncology departments were screened. Subsequently, 126 underwent DPC, and 122 were de-labelled. Twenty-two of these were de-labelled in time to affect their antibiotic regimen; 6 from AMU/IDU and 16 Pre-surgery. The DPC represented 22%-23% of the pathway cost in the pharmacist-led and mixed models, and 15% in the nurse-led model. Across departments and models, the cost per de-labelled patient varied between £577 (95% Credible Interval: 370, 633) for haematology-oncology patients to £2329 (947, 19,504) for AMU/IDU patients, both under the nurse-led model. After 5 years, recouping costs was unlikely for AMU/IDU patients under any model or for all patients combined under the mixed model.
conclusionsThe penicillin allergy de-labelling pathway cost was ≥ 4-fold that of the DPC alone. Costs were up to 3 times higher in an acute compared to an elective setting. No short-term cost savings were identified from proactive or opportunistic penicillin allergy de-labelling in this study.
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