The Delabeling of Penicillin Allergy in Hospitalized Patients

Patients with a penicillin allergy often face limited options for antibiotic treatment, which can sometimes be life-threatening. However, recent research suggests that many patients may be inaccurately labeled as allergic to penicillin. In a quality-improvement project conducted at a community hospital, Ibrahim Shah, MD, and his colleagues aimed to delabel patients with a penicillin allergy using methods that do not require specialist intervention or extensive testing. The results of their study indicate that delabeling based on medical history or oral challenges without skin testing can be effective, low-risk, and resource-efficient.

The Delabeling Process

At the beginning of the project, 56 inpatients had a penicillin allergy listed in their electronic health records (EHR). Of these patients, 38 were delabeled based on nonallergic reactions or previous penicillin exposure, as determined by medical history. Alternatively, delabeling was achieved through an oral challenge without skin testing. The researchers reported a 95% rate of oral challenges and a 67% overall delabeling rate. However, it is important to note that 13% of the patients had the penicillin allergy label re-added to their EHRs after 7 months. This finding aligns with current literature, which suggests that a significant portion of patients continue to retain a penicillin allergy label even after successful delabeling.

Dr. Shah believes that as many as 90% of patients labeled with a penicillin allergy are not truly allergic. Often, children acquire the label when they develop a rash after receiving penicillin or other medications. However, these rashes are usually mild and may be caused by factors unrelated to penicillin. Moreover, most of these reactions are outgrown by the time the child reaches adulthood. Despite this, the penicillin allergy label remains, limiting antibiotic treatment options unnecessarily.

Limitations of Current Delabeling Practices

Historically, penicillin allergies were delabeled by allergists or infectious disease specialists through skin testing followed by a confirmatory oral challenge. However, this approach is resource-intensive and not available at all centers. Furthermore, pharmacy-led delabeling programs are emerging but are often limited due to pharmacists not having provider status in all states. Shah’s study presents an alternative method for delabeling by directly performing oral challenges in low-risk patients.

Dr. Shah’s research suggests that delabeling inpatients with penicillin allergy using the approach implemented in the study is effective, carries minimal risk, and requires fewer resources. By delabeling patients who are not truly allergic, healthcare providers can expand the range of antibiotic treatment options and potentially improve patient outcomes. The study also highlights the need for continued research and improvement in the delabeling process. Ensuring accurate labeling of penicillin allergy is crucial for providing appropriate treatment to patients while minimizing unnecessary antibiotic restrictions.

The delabeling of penicillin allergy in hospitalized patients is an important aspect of healthcare. Through methods such as medical history review and oral challenges, healthcare providers can identify patients who are inaccurately labeled as penicillin allergic. This not only expands antibiotic treatment options but also avoids unnecessary restrictions that can have medical consequences. The emergence of alternative delabeling practices presents an opportunity to improve patient care and reduce the burden on specialized healthcare providers. Moving forward, further research and implementation of standardized delabeling protocols will be essential to ensure accurate labeling and effective, safe treatment for all patients.


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