Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists

Area of Science:

• Otolaryngology
• Allergy and Immunology
• Pharmacology

Background:

• A penicillin allergy label affects approximately 10% of patients, but up to 95% lack true immunoglobulin E (IgE)-mediated reactions.
• Penicillin allergy mislabeling results in adverse drug events, suboptimal treatment outcomes, and increased healthcare costs.

Purpose of the Study:

• To highlight the consequences of inaccurate penicillin allergy labeling in clinical and perioperative settings.
• To explore misconceptions about penicillin and cephalosporin cross-reactivity.
• To provide practical recommendations for rhinologists to aid in delabeling patients with questionable penicillin allergy histories.

Main Methods:

• Review of clinical implications of penicillin allergy mislabeling.
• Discussion of cross-reactivity between penicillins and cephalosporins.
• Exploration of interdisciplinary collaboration and shared decision-making.

Main Results:

• Inaccurate penicillin allergy labels are common and lead to significant negative health and economic consequences.
• Misconceptions regarding cross-reactivity contribute to continued mislabeling.
• Rhinologists are uniquely positioned to identify and correct inaccurate penicillin allergy designations.

Conclusions:

• Rhinologists can actively participate in delabeling patients with inaccurate penicillin allergies.
• Accurate penicillin allergy assessment ensures appropriate antibiotic selection for future medical needs.
• Improved antibiotic stewardship benefits patient outcomes and reduces healthcare expenditures.