Six percent of patients registered in general practice in England and 10% of patients in the US have a penicillin allergy label in their electronic health record [
1,
2]. For patients who are truly allergic it is important that these records are correct, as this safeguards against serious/deadly consequences of consuming penicillin. Penicillins have been the most common cause of drug-inducted fatal and nonfatal anaphylaxis in the US and UK, but fatalities are still rare [
3,
4]. However, it is also estimated that fewer than 10% of people who have a record of penicillin allergy are likely to be truly allergic to penicillins [
5] and an increase in mortality has also been associated with having a penicillin allergy record [
1].
Clinical confirmation of a historical diagnosis of penicillin allergy can be difficult for a number of reasons; there is often incomplete or inconsistent documentation of the reaction in medical records and patients may have no or limited recollection of the index event [
6,
7]. The reasons for incorrect penicillin allergy labelling are complex. Sometimes symptoms of infection, such a rash caused by a viral illness, can be confused with an allergic reaction. Similarly, side effects to a penicillin such as nausea or diarrhoea can also lead to patients being labelled as allergic [
8]. Understandably, PCPs have also concerns about missing penicillin allergy and causing serious reactions, especially if they have access to alternative antibiotics [
9].
Penicillins are generally highly effective, narrow-spectrum, inexpensive antibiotics and are the first line recommended treatment for many infections. Patients with a penicillin allergy record are prescribed penicillin much less frequently and they received a range of different antibiotics instead [
2]. In observational studies, patients with incorrect penicillin allergy records have been found to have longer hospital stays [
10], increased risk of surgical site infections [
11], treatment with potentially less effective and more costly antibiotics [
2,
12], and increased rates of infection with Methicillin-resistant
Staphylococcus aureus and
Clostridium difficile compared to non-penicillin allergic patients [
11‐
14]
These consequences have been recognised at policy level with the National Institute for Health and Care Excellence (NICE) advising clinicians to “double check patients with penicillin allergy” [
15]. American Academy of Allergy, Asthma, and Immunology also highlighted that penicillin allergy is a top priority public concern [
16]. Increasing numbers of studies are reporting on efforts to de-label patients with a penicillin allergy record in both primary and secondary care [
17‐
19]. There is some understanding of patient and clinician views of penicillin allergy testing and “de-labelling” (removal of records that are found to be incorrect). Previous studies highlighted that PCPs felt that patients may not want to get tested [
20] or may be worried about the safety of the test [
20], while others described difficulties such as lack of time, not knowing what the referral criteria were [
21] or lacking of access to any testing services [
22]. Limited questionnaire-based studies highlighted that patients were not really aware of penicillin allergy testing services but were interested in testing [
20,
23]. Our previous qualitative study explored in detail barriers and facilitators to patients attending, and PCPs referring for, penicillin allergy testing and subsequent use of penicillins [
24]. This study highlighted a number of issues needing to be considered to enhance the effectiveness of de-labelling programmes [
24], including the finding that clinicians felt that allergy testing could be beneficial but had limited experience of referring patients and similarly, that only patients who had experienced negative consequences of having penicillin allergy were motivated to get tested [
24]. However, there is still limited understanding of both the patient and PCP perspectives on penicillin allergy and delabelling [
25]. The current study builds on this work, by addressing an important research gap, identified by a number of recent reviews [
8,
26] which higlighted that the views of patients and clinicians have been missing so far and called for qualitative studies to explore these views and help support de-labelling efforts [
8,
26]. Thus, in the current study we have addressed the following research question: What are PCPs and patients views of penicilin allergy and their experiences of managing penicillin allergy in primary care?