Penicillin Allergy Delabeling in Pediatric Primary Care: A Multisite Qualitative Study

Allergy societies recommend penicillin allergy (PA) delabeling via history alone or following direct challenge in children at low risk for true PA. Recent studies demonstrate the safety of PA delabeling in pediatric primary care. We aimed to identify primary care practitioners' attitudes toward PA delabeling and perceived barriers and enablers to PA delabeling.

We conducted semistructured interviews (n = 11) and focus groups (n = 3) with 29 primary care practitioners of 2 health systems in the northeast United States. We coded transcripts using content analysis and mapped barriers and enablers to the Capability, Opportunity, and Motivation COM-B model of behavior.

Participants perceived PA delabeling to benefit children and shared prior attempts to delabel PAs in primary care. Barriers to PA delabeling included a lack of skills and training to delabel (capability), perceived caregiver resistance to delabel, inadequate time, staff, and space to delabel (opportunity), which led to mixed desires among practitioners to delabel (motivation). To enable PA delabeling in primary care, participants recommended partnership with allergists to implement a delabeling protocol, tools to engage caregivers in delabeling, innovative workflows and infrastructures to facilitate delabeling, and an amplification of reasons for delabeling to occur in pediatric primary care.

Primary care practitioners perceived PA delabeling as beneficial to children's health and specified intervention targets (enablers) to facilitate delabeling. To propel PA delabeling in pediatric primary care, interventions are needed to optimize practitioner skills, secure caregiver interest, and ensure the necessary resources, time, and space for practitioners to delabel.