Penicillin Allergy Delabeling: A Multidisciplinary Opportunity

Abstract

The penicillin allergy label has been consistently linked with deleterious effects that span the health care spectrum, including suboptimal clinical outcomes, the emergence of bacterial resistance, and increased health care expenditures. These risks have recently motivated professional organizations and public health institutes to advocate for the implementation of penicillin allergy delabeling initiatives; however, the burden of delabeling millions of patients is too expansive for any one discipline to bear alone. This review presents the unique perspectives and roles of various stakeholder groups involved in penicillin allergy diagnosis, assessment, and delabeling; we emphasize opportunities, barriers, and promising areas of innovation. We summarize penicillin allergy methods and tools that have proven successful in delabeling efforts. A multidisciplinary approach to delabeling patients with reported penicillin allergy, bolstered by evidence-based clinical practices, is recommended to reduce the risks that associate with the penicillin allergy label.

Keywords: Antibiotic; Beta-lactam; Cephalosporin; Delabel; Delabeling; Hypersensitivity; Utilization.

FIGURE 1.

Summary of risks of the penicillin allergy label. The figure summarizes why penicillin allergy delabeling is important to the quality and safety of health care delivered. Recent studies have identified associations that showed that patients with a penicillin allergy label have inferior outcomes, untoward effects, and increased costs. C. difficile, Clostridioides difficile; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus.

FIGURE 2.

Core elements of the drug allergy history. The figure includes elements important to the drug allergy history, considering details related to the patient, medication, and treatment. In addition to considering the reaction history, it is also important to consider the general and current health of the patient. Specific patient factors such as pregnancy or having an oxygen requirement because of poor lung function may make a patient “high risk” for penicillin allergy delabeling even when the reaction history is “low risk.” EBV, Epstein-Barr virus; ED, emergency department; NSAID, nonsteroidal anti-inflammatory drug.

FIGURE 3.

Multidisciplinary engagement opportunities for penicillin allergy delabeling. The figure summarizes the multidisciplinary opportunities and innovations that are critical to penicillin allergy delabeling efforts. ASP, Antibiotic Stewardship Program; EHR, electronic health record.