CATALYST: challenging antibiotic allergy status.

OBJECTIVES: To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital. METHODS: A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention. RESULTS: CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot. CONCLUSIONS: CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.

BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting.

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de-labelling service for their patients. It is intended to supplement the BSACI 2015 guideline "Management of allergy to penicillin and other beta-lactams" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta-lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy.

HIV testing: getting the message across--a survey of knowledge, attitudes and practice among non-HIV specialist physicians.

INTRODUCTION: 26% of people living with HIV in the UK remain undiagnosed and over 50% of adults with HIV are significantly immunocompromised at the time of diagnosis. Current guidelines recommend routine testing in all patients presenting with a range of conditions in low prevalence areas (< 2/1000). METHODS: The authors conducted an online survey of the knowledge, attitudes and practice of non-HIV specialist physicians with regard to HIV testing in two areas of the UK with a lower prevalence of HIV. Key outcomes included recognition of recommended clinical indications for HIV testing and perceived barriers to performing HIV tests more routinely. All responses were collected in July 2009. RESULTS: Recommended indications for HIV testing were identified by 0-43.7% of 119 respondents. 47.9% cited a low prevalence of HIV as a barrier to routine testing. 88% of 60 consultant physicians were unaware of current guidelines on testing for HIV. CONCLUSION: The authors found a low awareness of current guidance on testing for HIV and a high level of perceived barriers to testing. Reducing the high number of late diagnoses is a clinical and public health priority. To achieve this, the authors recommend improved policy dispersal coupled with education that targets perceived barriers to testing.

HIV testing in secondary care: a multicentre longitudinal mixed methods electronic survey of non-HIV specialist hospital physicians in South-East Scotland and Northern England.

BACKGROUND: Increasing the uptake of HIV testing in people who may have undiagnosed HIV is essential to reduce the morbidity associated with late HIV diagnosis. METHODS: We conducted a multicentre, longitudinal, mixed-methods study, surveying the attitudes, knowledge and practice of non-HIV specialist hospital physicians in South-East Scotland and North-East England with respect to HIV testing. RESULTS: We found that although awareness of indications for HIV testing had improved over time, only 13% of clinicians recognised all of the surveyed HIV indicator conditions. Physicians were better at recognising the indicator conditions relevant to their specialty. The perception of working with a low-risk patient population was the most frequently cited barrier to offering an HIV test. Only a third of study respondents had requested more than 10 HIV tests in the preceding year. CONCLUSIONS: Our study supports a need for targeted and sustained educational initiatives to increase rates of HIV testing in secondary care.