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

Penicillin allergy labels affect 1 in 10 people but are uncommonly reflective of a true, IgE-mediated allergy. Penicillin allergy-labeled patients have increased exposure to broad-spectrum antibiotics that increase the risk for treatment failures, antimicrobial resistance, and adverse events. Delabeling of penicillin allergy is an evidence-based strategy to support access to optimal antibiotics and reduce antimicrobial resistance.

To assess the association of race with penicillin allergy delabeling prevalence.

We used a retrospective cohort of primary care patients at Mass General Brigham and Tufts Medicine health systems receiving care from January 2019 to April 2022 with any active or inactive (ie, deleted or inactivated) penicillin allergy record in their electronic health record. We assessed penicillin allergy delabeled as the primary outcome, defined as no active penicillin allergy record in the electronic health record using a validated algorithm. The primary exposure was self-reported race in the electronic health record. We also assessed age, sex (at birth), language preference, documented allergies, health care visits, and Charlson comorbidity index as potential associated factors and mediators.

Black patients were less likely to have penicillin allergy delabeling overall (adjusted odds ratio 0.73 [95% CI 0.64-0.84]), but the prevalence and mediation differed across the 2 health care systems. Asian patients had lower penicillin allergy delabeling prevalence (adjusted odds ratio 0.76 [95% CI 0.65-0.88]), which was mediated in both systems by non-English language preference and specific health care utilization.

Racial differences were identified in penicillin allergy delabeling in Black and Asian patients, but with inconsistencies between health care systems. Further studies identifying the clinician-, institution-, and structural-level barriers to penicillin allergy delabeling are necessary to advance equitable penicillin allergy delabeling and antibiotic stewardship.