Penicillin allergy documentation in the UAE: 10-year trends and stewardship implications

Penicillin allergy labels are frequently documented in electronic medical records (EMRs), although most patients are not truly allergic upon formal evaluation. Inaccurate allergy labels result in unnecessary avoidance of first-line beta-lactam antibiotics, increased use of broad-spectrum alternatives, and contribute to antimicrobial resistance and healthcare-associated infections. Data describing allergy-label documentation and de-labelling practices in the United Arab Emirates remain limited.

This retrospective study examined temporal trends, documentation quality, and de-labelling patterns of penicillin and other beta-lactam allergy labels in EMRs from two tertiary care centres in Al Ain, United Arab Emirates, between 2015 and 2025. Extracted variables included age, sex, allergen class, adverse reaction type, reaction severity, duration of the documented allergy record, and de-labelling status.

A total of 35,134 penicillin allergy records and 6,317 other beta-lactam allergy records were identified. Adults and females accounted for most documented allergy labels. Documentation quality was suboptimal, with adverse reaction type and severity missing from the majority of records. De-labelling rates were higher for penicillin than for other beta-lactams but declined over time, decreasing from 16% in 2015 to approximately 10% in 2025. The annual proportion of documented penicillin allergy labels reached its lowest level in 2020 before increasing thereafter, whereas the proportion of other beta-lactam allergy labels remained relatively stable. De-labelling was more frequent among records documented for less than one year and among those classified as mild or involving cutaneous or gastrointestinal reactions, and less frequent among records documented for more than five years or classified as severe. Allergy-record duration reflected the time since first EMR documentation rather than the time since the original allergic reaction.

These findings demonstrate important gaps in allergy documentation and the persistence of incompletely characterized beta-lactam allergy labels within EMRs. Standardized documentation and structured, risk-stratified de-labelling strategies should be prioritized as part of antimicrobial stewardship programs to optimize beta-lactam utilization and help mitigate antimicrobial resistance.