BY TRISTIAN MILARCH, MPH
The Challenge of Mislabeling
Penicillin allergies are frequently misreported, with more than 90 percent of individuals who assert an allergy — often based on childhood experiences — being able to tolerate penicillin and related antibiotics when tested. This mislabeling poses
significant risks, particularly for vulnerable populations such as the elderly, immunocompromised, and homeless populations. Incorrectly avoiding penicillin can lead to the use of less effective treatments, increased antibiotic resistance,
a higher risk of adverse reactions, and elevated health care costs.
The Role of Physicians and Specialists
Traditionally, patients labeled as allergic to penicillin are referred to allergy specialists for skin testing. While studies suggest current skin tests have a sensitivity of only 31 percent, rendering them less effective, recent advancements
in real-time diagnostic tools and direct updates to medical records present a more efficient alternative, particularly for low-risk patients.
With the shortage of allergy specialists in the US, especially in urban academic settings, the role of physicians in raising awareness and guiding antibiotic choices is crucial. Integrating penicillin allergy reassessments into Antimicrobial Stewardship
Programs (ASPs) can enhance antimicrobial use by incorporating allergy assessments into training and protocols. This approach helps reduce reliance on broad-spectrum antimicrobials, contributing to better patient outcomes.
Educating and Empowering Patients
Another key component of effective delabeling is patient education. “The key is to make patients knowledgeable about the process and the benefits of penicillin allergy delabeling,” says Lynda G. Kabbash, MD, allergist-immunologist at Beth Israel
Deaconess Medical Center, sponsor of Resolution I-23 A-104, National Penicillin Allergy Day and Penicillin Allergy Evaluation and Appropriate Delabeling. “By educating patients, they are empowered to make informed decisions about their care,
improving overall treatment outcomes.”
Long-Term Impact
Incorporating penicillin allergy reassessment into ASPs as a standard practice can significantly improve antibiotic selection and patient care. Clinicians across disciplines can influence institutional protocols by promoting initiatives that address
broad-spectrum treatments commonly used for suspected beta-lactam allergies. Utilizing tools like preauthorization reviews and post-prescription audits, health care providers can enhance diagnostic practices and reduce unnecessary broad-spectrum
antimicrobial use, particularly in vulnerable populations.
Penicillin allergy evaluations are essential, as emphasized by guidelines such as the CDC’s Core Elements of Hospital Stewardship Programs. By embedding these assessments
into ASP training and expanding educational initiatives, health care leaders can significantly improve patient access to appropriate care while reducing the risks associated with mislabeling.
