What are patients' and healthcare professionals' views on managing penicillin allergy? A qualitative evidence synthesis.

Objectives: To review the existing literature on patients' and healthcare professionals' views on managing penicillin allergy and provide an interpretation of the evidence that will inform the development of strategies to increase penicillin allergy evaluation and testing. Methods: We systematically searched six databases for qualitative or mixed-methods studies reporting patients' and healthcare professionals' views on managing penicillin allergy. We followed three stages of thematic synthesis, including line-by-line coding, development of descriptive themes, and development of analytical themes, to analyse and interpret the findings of eligible studies. Results: We included 21 papers in the review and using thematic synthesis developed five analytical themes: (i) investigation of penicillin allergy was not a priority; (ii) healthcare systems did not support penicillin allergy assessment; (iii) penicillin allergy assessment required specific training; (iv) uncertainty over responsibility in managing penicillin allergy; and (v) management of penicillin allergy was associated with perception of risk and diagnostic uncertainty. Conclusions: To increase penicillin allergy assessment and testing, the lack of prioritization of penicillin allergy assessment in clinical practice should be addressed. Education of patients and healthcare professionals should emphasize the benefits of penicillin allergy assessment and explain the risks associated with allergy testing and subsequent use of penicillin. Healthcare systems-related barriers hindering penicillin allergy assessment could be reduced through the redesign of electronic medical records and the revision of antibiotic guidelines. Future research should explore novel models for penicillin allergy assessment services involving different healthcare settings.