[De-labeling of Penicillin Allergy in Hospitalized Patients: A Multidisciplinary Approach]

A label of "penicillin allergy" among hospitalized patients often leads to the use of second-line antibiotics. It has been demonstrated that alleged penicillin allergy is associated with prolonged hospitalization, increased risk of antimicrobial resistance, and higher mortality rates. Approximately 90% of reported penicillin allergies are inaccurate and may reflect adverse drug reactions or misinterpretation of medical history.

To evaluate penicillin allergy among hospitalized patients through an educational intervention program.

A prospective study implementing an intervention program aimed at removing inaccurate penicillin allergy labels in hospitalized patients in internal medicine and surgical departments. The intervention was carried out by the physicians of the department and supported by specialists in allergy and clinical immunology, infectious diseases, and clinical pharmacy. The program included educational lectures about drug allergies and clinical training in conducting penicillin drug provocation tests (DPT). A negative DPT result led to the removal of the allergy label from the patient's medical record.

Between January and October 2024, a total of 26,985 patients were admitted to the internal medicine departments and the surgical division at Meir Medical Center. Of these, 2,001 patients (7.4%) had a documented penicillin allergy label. Among the labeled patients, 114 (5.7%) underwent inpatient evaluation for penicillin allergy. In the internal medicine departments, 16,791 patients were hospitalized during the study period. Of these, 1,320 (7.8%) carried a penicillin allergy label, and 54 (4.0%) underwent evaluation as part of the de-labeling intervention. In departments where the structured program was implemented, 27 of 530 patients had their allergy label removed, compared with 27 of 790 patients in departments without the intervention (5% vs. 3.4%, p = 0.1). During the same period, 10,194 patients were admitted to the surgical division. Of these, 681 patients (6.6%) had a documented penicillin allergy label, and 60 (8.8%) underwent evaluation as part of the intervention program. In departments participating in the program (gynecology, otolaryngology, and orthopedics), 38 of 200 patients underwent inpatient assessment for penicillin allergy, compared with 22 of 481 patients in departments not participating in the intervention (19% vs. 4.5%, p < 0.01).

The intervention program led to a modest improvement in the rate of penicillin allergy label removal among hospitalized patients, with relatively greater success observed in surgical departments. We believe that the learning curve inherent to this process requires a prolonged implementation period. On-going application and refinement of the intervention, across both medical and surgical departments, may further reduce the prevalence of inaccurate allergy labeling.