Rising to the Challenge: An ID Provider-Led Initiative to Address Penicillin Allergy Labels at a Large Veterans...

Area of Science:

• Infectious Diseases
• Allergy and Immunology
• Quality Improvement

Background:

• Penicillin allergy labels carry negative consequences, yet delabeling initiatives are limited by allergist shortages.
• An infectious diseases section implemented a quality improvement initiative to address penicillin allergy label removal among inpatients.

Purpose of the Study:

• To evaluate and remove penicillin allergy labels in inpatient veterans.
• To assess the feasibility and outcomes of a penicillin allergy delabeling program led by infectious diseases specialists.

Main Methods:

• Inpatients with penicillin allergy labels were identified and interviewed to stratify risk.
• Delabeling was attempted via chart review, inpatient oral amoxicillin challenge, or outpatient referral.
• Outcomes including delabeling success, subsequent penicillin prescriptions, and relabeling were tracked.

Main Results:

• Of 154 interviewed patients, 53 (34%) were successfully delabeled.
• Delabeling occurred directly (26), via oral amoxicillin challenge (23), or outpatient referral (4).
• No adverse reactions were observed during oral amoxicillin challenges; only one inappropriate relabeling occurred.

Conclusions:

• An infectious diseases provider-led initiative effectively removed penicillin allergy labels in over one-third of evaluated inpatients.
• Direct removal and oral amoxicillin challenge were successful delabeling strategies.
• The initiative was particularly successful for patients admitted with infectious diseases.