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Racial differences in penicillin allergy delabeling in a multicenter US primary care cohort.

Kimberly G Blumenthal1, Valerie E Stone2, Bohang Jiang3

  • 1Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida; Harvard Medical School, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|November 29, 2025
PubMed
Summary

Penicillin allergy delabeling is less common in Black and Asian patients, with racial disparities varying by healthcare system. Addressing barriers is crucial for equitable antibiotic stewardship and reducing antimicrobial resistance.

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Area of Science:

  • Health Services Research
  • Infectious Diseases
  • Health Equity

Background:

  • Penicillin allergy labels affect 10% of individuals but often do not indicate true IgE-mediated allergy.
  • Inaccurate penicillin allergy labels increase broad-spectrum antibiotic use, contributing to treatment failures and antimicrobial resistance.
  • Penicillin allergy delabeling is an evidence-based strategy to improve antibiotic access and combat resistance.

Purpose of the Study:

  • To investigate the association between patient race and the prevalence of penicillin allergy delabeling.
  • To identify potential mediating factors in racial disparities in penicillin allergy delabeling.

Main Methods:

  • Retrospective cohort study of primary care patients across two health systems (January 2019-April 2022).
  • Penicillin allergy delabeling was the primary outcome, defined by the absence of an active allergy record.
  • Self-reported race was the primary exposure, with analyses adjusting for age, sex, language preference, comorbidities, and healthcare utilization.

Main Results:

  • Black patients exhibited lower odds of penicillin allergy delabeling (aOR 0.73).
  • Asian patients also showed lower delabeling prevalence (aOR 0.76), with non-English language preference and healthcare utilization as significant mediators.
  • Racial disparities in delabeling varied in prevalence and mediation across the two healthcare systems.

Conclusions:

  • Significant racial differences exist in penicillin allergy delabeling, particularly for Black and Asian patients.
  • Inconsistencies between healthcare systems highlight the need for further investigation into clinician, institutional, and structural barriers.
  • Advancing equitable delabeling practices is essential for effective antibiotic stewardship and mitigating antimicrobial resistance.