Nottingham and Nottinghamshire Integrated Care Board is taking action to change how penicillin allergies are recorded after the death of 27-year-old Jennifer Susan Birch. She suffered a fatal anaphylactic reaction to a prophylactic antibiotic administered during an elective procedure in April 2025. Because her medical records indicated a penicillin allergy, clinicians chose an alternative antibiotic, which unfortunately caused the severe reaction that led to her death.
Following a coroner's report on the tragedy, the local health board is launching a stakeholder group to develop a new de-labelling model. Research shows that while nearly 10% of the population carries a record of penicillin allergy, over 90% of those labels are inaccurate. Incorrect documentation forces doctors to use alternative antibiotics, which can increase the risk of surgical site infections, complicate care, and prolong hospital stays.
This new initiative intends to use pharmacy teams, primary care, and antimicrobial stewardship experts to identify patients who do not have a true allergy. By verifying these records, the board aims to reduce reliance on second-line medications and improve patient safety across the region. Other trusts, such as Doncaster and Bassetlaw, have already implemented successful de-labelling pathways to address this issue.
Evidence confirms that non-allergy healthcare professionals can safely perform risk stratification and oral challenges for low-risk patients. By moving this responsibility out of the constrained allergy services, the board hopes to ensure a more efficient system that protects patients from unnecessary complications. Work is now underway to integrate this approach into existing clinical pathways.