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This review assesses an emergent evidence base and trend favouring delabelling using <jats:italic>direct<\/jats:italic> oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these <jats:italic>direct<\/jats:italic> delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems.<\/jats:p>","DOI":"10.1111\/bcp.14190","type":"journal-article","created":{"date-parts":[[2019,12,11]],"date-time":"2019-12-11T05:59:34Z","timestamp":1576043974000},"page":"548-559","source":"Crossref","is-referenced-by-count":28,"title":["Sustaining and spreading penicillin allergy delabelling: A narrative review of the challenges for service delivery and patient safety"],"prefix":"10.1111","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5927-5429","authenticated-orcid":false,"given":"Yogini H.","family":"Jani","sequence":"first","affiliation":[{"name":"Centre for Medicines Optimisation Research and Education UCLH NHS Foundation Trust &amp; UCL School of Pharmacy  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iestyn","family":"Williams","sequence":"additional","affiliation":[{"name":"Health Services Management Centre University of Birmingham  Birmingham West Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2109-5777","authenticated-orcid":false,"given":"Mamidipudi Thirumala","family":"Krishna","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust and Institute of Immunology and Immunotherapy University of Birmingham  Birmingham West Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,23]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Public Health England (PHE): English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2018In London:Public Health England (PHE) 2018."},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19283"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz127"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.13044"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.02.019"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2013.02.002"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.05.025"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13848"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32218-9"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2400"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.09.021"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2018.11.020"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ394"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202438"},{"key":"e_1_2_5_16_1","unstructured":"Safety in doses.Improving the use of medicines in the NHS. 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