Proactive Penicillin Allergy Delabeling: Lessons Learned From a Quality Improvement Project

Area of Science:

• Clinical Medicine
• Allergy and Immunology
• Primary Care Practice

Background:

• Approximately 9% of patients have a documented penicillin allergy, but only 10% are truly allergic.
• Incorrect penicillin allergy labeling poses a significant burden on healthcare systems and patient care.
• Penicillin delabeling traditionally performed by allergists needs integration into primary care settings.

Purpose of the Study:

• To evaluate a program training primary care practitioners (PCPs) in penicillin allergy delabeling.
• To assess the efficacy and safety of using the PEN-FAST clinical criteria and oral challenges in primary care.
• To determine if PCPs can effectively identify low-risk patients for delabeling.

Main Methods:

• A program was implemented to train PCPs on the PEN-FAST criteria for identifying low-risk patients.
• Low-risk patients underwent oral penicillin challenges in a primary care setting with emergency resources.
• Skin testing was utilized in a minority of cases (18%).

Main Results:

• The program successfully trained PCPs to conduct penicillin allergy testing and delabeling.
• Most penicillin allergy labels were cleared using clinical criteria and oral challenge alone.
• 94% of tested patients tolerated the oral challenge and were successfully delabeled.

Conclusions:

• The PEN-FAST criteria and oral challenge model show significant potential for penicillin allergy delabeling in primary care.
• Expanding PCP training for oral challenges can reduce the burden of incorrect penicillin allergy diagnoses.
• This approach enables appropriate antibiotic selection for patients previously mislabeled.