Background Direct drug provocation testing (DPT) in patients with low-risk penicillin allergy labels would allow population-level de-labelling. We sought to determine the incidence and nature of penicillin allergy labels in a large UK surgical cohort and to define patient and anaesthetist attitudes towards penicillin allergy testing. Methods A prospective cross-sectional study was performed in 213 UK hospitals. Penicillin allergic patients were interviewed and risk-stratified. Knowledge and attitudes around penicillin allergy were defined in patients and anaesthetists, determining potential barriers to widespread testing. Findings Of 21,281 patients 12% self-reported penicillin allergy and 67% of these were potentially suitable for direct DPT (stratified low or intermediate risk). Irrespective of risk category 62% wanted allergy testing. Of 4,978 anaesthetists 40% claimed to routinely administer penicillin when they judge the label to be low-risk; 64% would then tell the patient they had received penicillin. Only 47% of all anaesthetists would be happy to administer penicillin to a patient previously de-labelled by an allergy specialist using direct DPT; the commonest reason not to administer penicillin was perceived lack of support from their hospital. On the study days, 13% of low-risk patients requiring penicillin received it, and 6 patients with high-risk labels received it. There were no adverse events in any of this group. However, 1 patient who received an alternative antibiotic suffered suspected anaphylaxis to this. Interpretation The majority of patients with a penicillin allergy label may be suitable for direct DPT and demand for testing is high among patients. Anaesthetists demonstrate inconsistent, potentially unsafe prescribing in patients labelled as penicillin allergic. More than half of anaesthetists are not reassured by a negative DPT undertaken by a specialist. Significant knowledge gaps may prevent widespread de-labelling being effectively implemented in surgical patients.

中文翻译：

---

DALES-前瞻性横断面研究，涉及青霉素过敏标签的发生率，真实过敏的风险以及患者和麻醉师对去标签策略的态度

背景对具有低风险青霉素过敏标签的患者进行直接药物激发试验（DPT），可以进行人群水平的去标签。我们试图确定大型英国外科手术队列中青霉素过敏标签的发生率和性质，并确定患者和麻醉师对青霉素过敏测试的态度。方法在英国的213家医院进行了一项前瞻性横断面研究。对青霉素过敏患者进行了访谈并进行了风险分层。在患者和麻醉师中定义了有关青霉素过敏的知识和态度，从而确定了广泛测试的潜在障碍。结果在21,281名患者中，自我报告的青霉素过敏率为12％，其中67％可能适合直接DPT（分层的中低危）。不论风险类别如何，有62％的人希望进行过敏测试。的4 978名麻醉师中有40％的人声称他们认为该标签为低风险药物后会常规使用青霉素；然后，有64％的患者会告诉患者他们已经接受了青霉素治疗。只有47％的麻醉师愿意对以前由过敏专家使用直接DPT取消标签的患者服用青霉素；不服用青霉素的最常见原因是医院缺乏支持。在研究期间，需要青霉素的低风险患者中有13％接受了青霉素，有高风险标签的6名患者中接受了青霉素。该组中没有任何不良事件。但是，有1位接受替代抗生素的患者怀疑对此有过敏反应。解释大多数具有青霉素过敏标签的患者可能适合直接DPT，并且患者之间的测试需求很高。麻醉师对标记为青霉素过敏的患者开具不一致，可能不安全的处方。麻醉师对DPT的负面评价并不能使一半以上的麻醉师放心。巨大的知识鸿沟可能会阻止在外科手术患者中有效实施广泛的取消标记。