{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:28:58Z","timestamp":1792794538133,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"The Leeds Teaching Hospitals NHS Trust","id":[{"id":"https:\/\/ror.org\/00v4dac24","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Leeds Institute of Health Sciences","id":[{"id":"https:\/\/ror.org\/03gxfng04","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["ALABAMA RP-PG-1214-20007"],"award-info":[{"award-number":["ALABAMA RP-PG-1214-20007"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine: (i) prevalence of PenA records; (ii) patient characteristics associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing\/health outcomes in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out cross-sectional\/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing, mortality, MRSA infection\/colonization and Clostridioides difficile infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PenA prevalence was 5.9% (IQR\u205f=\u205f3.8%\u20138.2%). PenA records were more common in older people, females and those with a comorbidity, and were affected by GP practice. Antibiotic prescribing varied significantly: penicillins were prescribed less frequently in those with a PenA record [relative risk (RR) \u205f=\u205f0.15], and macrolides (RR\u205f=\u205f4.03), tetracyclines (RR\u205f=\u205f1.91) nitrofurantoin (RR\u205f=\u205f1.09), trimethoprim (RR\u205f=\u205f1.04), cephalosporins (RR\u205f=\u205f2.05), quinolones (RR\u205f=\u205f2.10), clindamycin (RR\u205f=\u205f5.47) and total number of prescriptions were increased in patients with a PenA record. Risk of re-prescription of a new antibiotic class within 28\u2009days (RR\u205f=\u205f1.32), MRSA infection\/colonization (RR\u205f=\u205f1.90) and death during the year subsequent to 1 April 2013 (RR\u205f=\u205f1.08) increased in those with PenA records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PenA records are common in the general population and associated with increased\/altered antibiotic prescribing and worse health outcomes. We estimate that incorrect PenA records affect 2.7 million people in England. Establishing true PenA status (e.g. oral challenge testing) would allow more people to be prescribed first-line antibiotics, potentially improving health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkz127","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T09:08:08Z","timestamp":1552986488000},"page":"2075-2082","source":"Crossref","is-referenced-by-count":123,"title":["\u2018Warning: allergic to penicillin\u2019: association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes"],"prefix":"10.1093","volume":"74","author":[{"given":"R M","family":"West","sequence":"first","affiliation":[{"name":"Leeds Institute for Health Sciences, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C J","family":"Smith","sequence":"additional","affiliation":[{"name":"Leeds Institute for Health Sciences, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S H","family":"Pavitt","sequence":"additional","affiliation":[{"name":"School of Dentistry, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0102-3453","authenticated-orcid":false,"given":"C C","family":"Butler","sequence":"additional","affiliation":[{"name":"University of Oxford Primary Care Clinical Trials Unit, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Howard","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Bates","sequence":"additional","affiliation":[{"name":"TPP House, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7910-0554","authenticated-orcid":false,"given":"S","family":"Savic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M","family":"Wright","sequence":"additional","affiliation":[{"name":"Leeds Institute for Health Sciences, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Hewison","sequence":"additional","affiliation":[{"name":"Leeds Institute for Health Sciences, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0193-8677","authenticated-orcid":false,"given":"J A T","family":"Sandoe","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,10]]},"reference":[{"key":"2019091011534109200_dkz127-B1","year":"2014"},{"key":"2019091011534109200_dkz127-B2","doi-asserted-by":"crossref","first-page":"778.e1","DOI":"10.1016\/j.amjmed.2009.01.034","article-title":"Self-reported antibiotic allergy incidence and prevalence: age and sex effects","volume":"122","author":"Macy","year":"2009","journal-title":"Am J Med"},{"key":"2019091011534109200_dkz127-B3","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jaci.2013.09.021","article-title":"Health care use and serious infection prevalence associated with penicillin \u2018allergy\u2019 in hospitalized patients: a cohort study","volume":"133","author":"Macy","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"2019091011534109200_dkz127-B4","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/j.1742-7843.2006.pto_230.x","article-title":"The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population","volume":"98","author":"Borch","year":"2006","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"2019091011534109200_dkz127-B5","doi-asserted-by":"crossref","first-page":"2498","DOI":"10.1001\/jama.285.19.2498","article-title":"The rational clinical examination. 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