A physician-led effort to remove penicillin allergy labels from low-risk patients at a Veterans Administration medical center removed the label in more than a third of those who were evaluated, researchers from Texas reported today in Open Forum Infectious Diseases.

Earlier studies have found that more than 95% of people reporting penicillin allergies, often labeled during childhood, are not truly allergic to penicillin and other beta-lactam antibiotics. The mislabeling or outdated labeling is a clinical problem, because patients with infections who don't have true penicillin allergies often receive antibiotics that aren't as effective, are more expensive, or are broad-spectrum antibiotics that increase the risk of Clostridium difficile and other adverse reactions.
Between November 2022 and December 2023, researchers screened 272 inpatient veterans who had penicillin allergy labels and interviewed 154 for possible delabeling. They delabeled 53 patients, 26 directly, 23 after an oral amoxicillin challenge, and 4 after outpatient allergy referral. Though the facility is large, it doesn't have onsite allergy physician coverage.
Successful results in patients with underlying comorbidities
Of the 53 patients who were delabeled, 25 later received penicillin-class prescriptions. No adverse events occurred in those who had undergone oral amoxicillin challenge. Researchers found that patients with low-risk penicillin allergy history were more likely to undergo a challenge if admitted with an infectious disease.
Only one inappropriate relabeling event occurred, which the team corrected.
The researchers concluded that the findings demonstrate a successful provider-led system for removing penicillin allergy labels in US veterans who have complex comorbidities. "These findings add to the body of literature supporting the inpatient use of oral amoxicillin challenges by non-allergy providers as a means of expanding access to penicillin allergy evaluation," they wrote.