Penicillin allergy risk stratification tool for use by non-allergists in the peri-operative setting: an agreement study and qualitative process evaluation.
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All Authors
Dias, P.
Walshaw, E.
Flatau, S.
O'Grady, E.
Hopkins, PM.
Garvey, LH.
Littlejohns, A.
Rousseau, N.
Pearse, RM.
Shinkins, B.
LTHT Author
Walshaw, Emma
Flatau, Samuel
Littlejohns, Anna
Savic, Louise
Flatau, Samuel
Littlejohns, Anna
Savic, Louise
LTHT Department
Theatres & Anaesthetics
Anaesthetics
Doctors' Rotation
Anaesthetics
Doctors' Rotation
Non Medic
Publication Date
2025
Item Type
Journal Article
Language
Subject
Subject Headings
Abstract
INTRODUCTION: Many patients are labelled incorrectly as 'penicillin allergic'. This label is associated with poor health outcomes, regardless of whether the allergy is genuine. We designed a study to assess agreement between allergy specialists (consultant allergists or immunologists) and non-allergists when using a risk stratification tool to determine suitability for a penicillin challenge test.
METHODS: In this two-centre mixed-method study, adult patients undergoing surgery who had been labelled penicillin allergic were assessed by a healthcare professional with no formal allergy training (consultant anaesthetist or peri-operative nurse) and an allergy specialist doctor using the risk stratification tool. Cohen's kappa was used to quantify agreement. We conducted a qualitative process evaluation based on individual and group interviews to explore user experience.
RESULTS: We recruited 139 patients and 11 healthcare professionals; 101 patients completed both assessments (median (IQR [range]) age was 53 (40-66 [19-86]) y, 71% women). Allergist and non-allergist assessments agreed for 63 (62%) patients. In the remaining 38 (38%), most disagreements represented an overcautious approach by non-allergists, except in seven patients categorised as unsuitable (or uncertain) by the allergist but suitable by the non-allergist. Inter-rater agreement was moderate (unweighted kappa 0.43, 95%CI 0.30-0.57; weighted kappa 0.47, 95%CI 0.27-0.67). The prevalence and bias-adjusted score indicated poor inter-rater reliability (kappa score 0.25, 95%CI 0.06-0.44). Qualitative analysis indicated low confidence in the tool among non-allergists, with a perceived need for allergy training and specialist support.
DISCUSSION: This penicillin allergy risk stratification tool, designed for use by healthcare professionals with no formal allergy training, showed poor agreement with allergy expert assessments.
Journal
Anaesthesia