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Penicillin allergy delabeling in a German University Hospital-implementation in inpatient settings: the PenGuin Pilot
Hannah Nürnberg1,2, Katrin Hörth3, Kristin Egenberger3
1Hospital Pharmacy, University Hospital Heidelberg, Heidelberg, Germany. Hannah.nuernberg@med.uni-heidelberg.de.
Background:
Penicillin allergy (PenA) is reported in up to 15% of hospitalized patients, although true IgE-mediated hypersensitivity is rare. PenA delabeling is an important antimicrobial stewardship intervention, as mislabeling is associated with adverse clinical outcomes. While structured delabeling interventions are safe and effective, their translation into routine care across different healthcare settings remains unclear.
Methods:
This prospective implementation study was conducted on four wards of a 2600-bed German tertiary care center. All adult inpatients with reported PenA underwent structured allergy assessment and risk stratification by clinical pharmacists. Low risk patients were delabeled directly, while moderate-risk patients were evaluated for direct oral challenge (DOC). Outcomes included delabeling rate at discharge, ward-specific differences, and implementation barriers and facilitators assessed by staff questionnaires. Sustainability was evaluated by primary care follow-up 32 weeks after discharge.
Results:
Among 2890 screened patients, 179 (6.2%) reported a PenA. Of 162 eligible patients, 54 (33.3%) were successfully delabeled. DOC was well tolerated, with only one mild skin reaction observed. Ward-specific environments influenced the use of different delabeling strategies. Key barriers included staffing shortages, short hospital stays, and patient-related factors, whereas facilitators included easy integration into pharmacist workflows and interprofessional collaboration. Follow-up showed limited transfer of delabeling outcomes to primary care, reducing long-term sustainability.
Conclusion:
Pharmacist-led PenA delabeling can be safely integrated and is feasible within existing clinical workflows. However, real-world implementation barriers and incomplete transfer to primary care limited its full potential. Improve standardized documentation and cross-sector communication are important for sustainable and widespread implementation of delabeling strategies.
