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Electronic Consultation-Driven Penicillin Allergy Delabeling in Pregnancy
Nonie Arora1, Carolina Alvarez1, Hema Chagarlamudi1
1Department of Internal Medicine, Division of Rheumatology, Allergy, and Immunology, Department of Obstetrics and Gynecology, General Obstetrics, Gynecology and Midwifery Division, and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina; and University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Abstract:
We evaluated an electronic consultation (e-consult) pathway for penicillin allergy delabeling in pregnancy in a retrospective cohort of patients referred between November 2022 and December 2024. Obstetric clinicians submitted structured allergy histories to allergists who recommended delabeling or in-person evaluation with skin testing and/or oral challenge. Among 117 patients, 60% were delabeled overall, and 82% completing evaluation were delabeled. Delabeling occurred via history (23%), skin testing (21%), and direct oral challenge (56%), and antibiotic therapy changed in 21% of patients. In multivariable models, private insurance was associated with higher odds of delabeling (OR 3.72, 95% CI 1.55-8.89). Our work supports e-consults for efficient risk stratification and direct oral challenge in low-risk patients.
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