Bulletin references October 2026

You can read the October 2026 Bulletin here.

Allergy

Tackling antimicrobial stewardship, health inequalities and spurious penicillin allergy labels in the UK

  1. Naghavi M, Vollset SE, Ikuta KS, Swetschinski LR, Gray AP, Wool EE et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Lancet 2024;404(10459):1199–1226.
  2. Ho CS, Wong CT, Aung TT, Lakshminarayanan R, Mehta JS, Rauz S et al. Antimicrobial resistance: a concise update. Lancet Microbe 2025;6:100947.
  3. UK Government. UK 5-year action plan for antimicrobial resistance 2024 to 2029. Available at: www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029
  4. Cooper LN, Beauchamp AM, Ingle TA, Diaz MI, Wakene AD, Katterpalli C et al. Socioeconomic disparities and the prevalence of antimicrobial resistance. Clin Infect Dis 2024;79(6):1346–1353.
  5. UK Health Security Agency. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2024–2025 report. Available at: www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report
  6. UK Health Security Agency. UK Access, Watch, Reserve, and Other classification for antibiotics (UK-AWaRe antibiotic classification). Available at: www.gov.uk/government/publications/uk-aware-antibiotic-classification
  7. West RM, Smith CJ, Pavitt SH, Butler CC, Howard P, Bates C et al. Warning: allergic to penicillin: association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes. J Antimicrob Chemother 2019;74(7):2075-2082.
  8. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014;133(3):790–796.
  9. Blumenthal KG, Parker RA, Shenoy ES, Walensky RP. Improving clinical outcomes in patients with methicillin-sensitive Staphylococcus aureus bacteremia and reported penicillin allergy. Clin Infect Dis 2015;61(5):741–749.
  10. Savic L, Ardern-Jones M, Avery A, Cook T, Denman S, Farooque S et al. BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. Clin Exp Allergy 2022;52(10):1135–1141.
  11. Krishna MT, Bhogal R, Ng BY, Kildonaviciute K, Jani YH, Williams I et al. A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling ‘low risk’patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): implications for healthcare systems. J Infect 2024;88(3):106116.
  12. Sandoe JA, Ahmed S, Armitage K, Bates C, Bestwick R, Boards J et al. Penicillin allergy assessment pathway versus usual clinical care for primary care patients with a penicillin allergy record in the UK (ALABAMA): an open-label, multicentre, randomised controlled trial.  Lancet Primary Care 2025;1(1)10006.
  13. Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi KY. Risk of methicillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ 2018;361:k2400.
  14. National Allergy Strategy Group. UK National Allergy Strategy. Available at: https://nasguk.org/
  15. Erlewyn-Lajeunesse M, Perfetti Villa L, Shaikh S, Smith M, Balodima V, Baker S et al. Inequalities in access to specialist allergy services in the United Kingdom: a report from the BSACI Registry for Immunotherapy (BRIT). Clin Exp Allergy 2025;55(6):458–468.
  16. Powell N, Blank M, Luintel A, Elkhalifa S, Bhogal R, Wilcock M et al. Narrative review of recent developments and the future of penicillin allergy de-labelling by non-allergists. NPJ Antimicrob Resist 2024;2:18.
  17. Trubiano JA, Vogrin S, Chua KYL, Bourke J, Yun J, Douglas A et al. Development and validation of the PEN-FAST clinical decision rule. JAMA Intern Med. 2020;180:745–752.
  18. Weaver M, Huffman J, Rice L, Johnson M, Hickey S, Mense K et al. Low-risk inpatient penicillin allergy delabeling by the nonallergist physician, a pilot study. Ann Allergy Asthma Immunol 2024;133:S13–S14.
  19. Scottish Antimicrobial Prescribing Group (SAPG). Penicillin Allergy De-labelling Toolkit. Available at: www.sapg.scot/guidance-qi-tools/quality-improvement-tools/penicillin-allergy-de-labelling/
  20. National Institute for Health and Care Research. Removing erroneous penicillin allergy labels (REPeAL). Available at: https://fundingawards.nihr.ac.uk/award/NIHR300542
  21. Porter CE, Roleston C, Bethune C, Boards J, Brown CS, Clarke I et al. Widening access to penicillin allergy assessment in the United Kingdom: a proposed implementation plan for the National Health Service (NHS). JAC Antimicrob Resist 2026;8:dlaf240.
  22. Norfolk and Suffolk ICB. Penicillin allergy assessment in primary care and community services (for adult patients). Available at: https://nwknowledgenow.nhs.uk/content-category/prescribing-pharmacy-and-medicines-optimisation/norfolk-legacy-documents-and-links/pathways-and-prescribing-guidance/antimicrobial-stewardship/projects/penicillin-allergy-de-labelling-project/

On the agenda

Occult hepatitis B and immunosuppression: closing the gap between testing and long-term monitoring

  1. Sagnelli E, Coppola N, Pisaturo M, Masiello A, Messina V, Sagnelli C et al. Clinical impact of occult hepatitis B virus infection in immunosuppressed patients. J Med Virol 2014;86(3):417–423.
  2. Im YR, Jagdish R, Leith D, Kim JU, Yoshida K, Majid A et al. Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022;7(10):932–942.
  3. Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT. American Gastroenterological Association Institute Guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015;148:215–219.
  4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2025;83:502–583.

Sharing our subject

2026 Hugh Platt Foundation Essay Prize winning essay

  1. Lynn RM, Avis JL, Lenton S, Amin-Chowdhury Z and Ladhani SN. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Archives of Disease in Childhood 2021;doi: 10.1136/archdischild-2020-319848.
  2. Foster AA, Walls TA, Alade KH, Brown K, Gausche‐Hill M, Lin SD et al (2023). Review of pediatric emergency care and the COVID‐19 pandemic. Journal of the American College of Emergency Physicians Open 2023;doi:10.1002/emp2.13073.
  3. Conlon C, McDonnell T, Barrett M, Cummins F, Deasy C, Hensey C et al. The impact of the COVID-19 pandemic on child health and the provision of Care in Paediatric Emergency Departments: a qualitative study of frontline emergency care staff. BMC Health Services Research 2021;doi:10.1186/s12913-021-06284-9.
  4. Centers for Disease Control and Prevention. Labs. Published 2020. Available at: https://archive.cdc.gov/www_cdc_gov/coronavirus/2019-ncov/lab/naats.html.
  5. Garibyan L and Avashia N. Polymerase chain reaction. Journal of Investigative Dermatology, 2013;doi.org/10.1038/jid.2013.1.
  6. Shao L, Guo Y, Jiang Y, Liu Y, Wang M, You C and Liu Q. Sensitivity of the Standard Chlamydia trachomatis Culture Method Is Improved After One Additional In Vitro Passage. Journal of Clinical Laboratory Analysis 2016;30:697–701. doi:10.1002/jcla.21924. [Accessed April 2026].
  7. Ángel M, Héctor Toledo Porteros De A, Medel JV and Borrero IG (2024). Advantages of Syndromic Diagnostics: Detection of the Pathogens Causing Urethritis/Cervicitis with the STI CNM Real-Time PCR Kit from Vitro S.A. Polish Journal of Microbiology 2024;doi:10.33073/pjm-2024-045.
  8. Department of Health and Social Care. Public Health England. Fingertips | Public health profiles. Accessed April 2026. Available at: fingertips.phe.org.uk/search/gonorrhoea.
  9. European Centre for Disease Prevention and Control. Surveillance Atlas of Infectious Diseases. Published 2023. Available at: atlas.ecdc.europa.eu/public/index.aspx.
  10. Sawyer A, Aicken C, Huber JW, Vera J, Williams D, Ali M et al. Contraceptive and sexual health services during the COVID-19 pandemic and recovery: a mixed-methods study in England. Reproductive Health 2026;doi:10.1186/s12978-025-02184-x.
  11. Fountain H, Migchelsen SJ, Charles H, Ram T, Fifer H, Mohammed H and Sinka, K. Rebound of Gonorrhea after Lifting of COVID-19 Preventive Measures, England. Emerging Infectious Diseases 2024;doi:10.3201/eid3002.231148.
  12. World Health Organization. Chlamydia. Accessed 2026. Available at: www.who.int/news-room/fact-sheets/detail/chlamydia.

People

What makes a pathway sustainable?

  1. Saal LH, Vallon-Christersson J, Häkkinen J , Hegardt C, Grabau D, Winter C et al. The Sweden Cancerome Analysis Network - Breast (SCAN-B) Initiative: a large-scale multicenter infrastructure towards implementation of breast cancer genomic analyses in the clinical routine. Genome Medicine 2015;7.

Patients, blood tests and the need for clear communication

  1. Zhang Z, Citardi D Xing A, Luo X, Lu Y, He Z. Patient challenges and needs in comprehending laboratory test results: Mixed methods study. J Med Internet Res 2020;22:e18725.
  2. Watson J, Duncan P, Burrell A, Bennett-Briton I, Hodgson S, Merriel SWD et al. Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic Collaborative (PACT). BMJ Open Qual 2024;13:e002632.
  3. Hawkins R, Foulsham J. Helping users do more with their results. 2026. Available at: https://design-history.prevention-services.nhs.uk/managing-my-health/2026/07/helping-users-do-more-with-results/
  4. Lab Tests Online. Lab Tests Online UK. Available at: https://labtetsonline.org.uk