Asking about drug allergies: Managing antimicrobial medicines-related risks in primary care in England and Sweden.

OBJECTIVE: Penicillins are the most common cause of drug-induced anaphylaxis worldwide, yet penicillin allergy status is seldom clinically tested and therefore reliant on patient report. Managing risk of harm is fraught with uncertainties: patients may not always be truly allergic and medical records may not be accurate. The aim of this study was to investigate how conversations about drug allergy risks unfold when prescribing for common infections. METHOD: We screened 156 acute primary care consultations for adult patients presenting with upper respiratory concerns in England and Sweden to identify all cases where drug allergies were raised. Data are in British English and Swedish. We used conversation-analytic methods to make systematic observations on how the topic was initiated; the activity context; the patient's response and any subsequent mention of drug allergy; identifying recurrent patterns within and across the two datasets. RESULTS: In both datasets, drug allergies were raised in just over one third of consultations most often via questions conveying a bias towards a 'no allergy' outcome. When asked during information-gathering, the question was sometimes misunderstood as asking about allergies in general. In the majority of cases, no allergies were reported, yet patients often qualified their 'no allergy' answers displaying uncertainty. Patients who did report allergies were seldom questioned about the nature of their symptoms. Where patient allergy status was contested or neglected by doctors and brought to the interactional surface, work was done by both parties to maintain neutrality or display cautiousness around different territories of knowledge. CONCLUSION: Our analysis reveals common interactional problems faced by prescribing professionals when managing the risk of patient harm from drug allergies when recommending antimicrobials. PRACTICE IMPLICATIONS: This study has provided pre-intervention evidence for how drug allergy checking can be improved. Other simple changes may help to identify low-risk individuals for future testing.