Association of a Reported Penicillin Allergy Label With Clinical Outcomes in Alcohol-Associated Liver Disease

Penicillin allergy is commonly reported but often unconfirmed, leading to avoidance of first-line antibiotics. Patients with alcohol-associated liver disease (ALD) are particularly vulnerable to infections and hepatic complications; however, the impact of a documented penicillin allergy label on clinical outcomes in this population remains unclear.

We conducted a retrospective cohort study using the TriNetX research network. Adults with ALD were classified by the presence or absence of a documented penicillin allergy label. After 1:1 propensity score matching on demographics, comorbidities, laboratory parameters, and treatments, 2388 patients were included, with 1194 in each cohort. Patients were followed for up to 5 years. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

A documented penicillin allergy label was associated with higher risks of sepsis (11.4% vs. 6.4%; HR, 1.53; 95% CI, 1.16-2.02), pneumonia (8.7% vs. 5.0%; HR, 1.49; 95% CI, 1.09-2.05), urinary tract infection (11.7% vs. 6.6%; HR, 1.55; 95% CI, 1.17-2.04), influenza pneumonia (10.7% vs. 6.1%; HR, 1.51; 95% CI, 1.12-2.04), and alcohol-associated hepatitis (19.0% vs. 13.5%; HR, 1.27; 95% CI, 1.04-1.55). The association with major adverse liver outcomes was not significant (9.5% vs. 6.9%; HR, 1.18; 95% CI, 0.89-1.57).

In patients with ALD, a documented penicillin allergy label was associated with several infection-related outcomes and alcohol-associated hepatitis, but not with major adverse liver outcomes. Formal penicillin allergy evaluation may help optimize antibiotic selection in this high-risk population.