ED visits may represent opportunity to de-label false penicillin allergies

Assessments in the ED can identify patients who are eligible to have a penicillin allergy removed from their electronic health record, according to findings of a pilot study presented virtually at the SHEA Spring Conference.

Ashlyn Norris, PharmD, a pharmacist at the University of North Carolina Medical Center, and colleagues presented research showing that, because of the volume of patients treated in the ED, it is an important setting to assess penicillin allergies and de-label suitable patients.

Norris and colleagues conducted a prospective, single-center study of adults with a documented penicillin allergy who presented to the ED between Dec. 1 and Dec. 17, 2020. Pharmacists interviewed 62 patients (67.7% women; 64.5% white) “using a standard tool,” gathered medical history data and updated patient charts — including de-labeling penicillin allergy — where appropriate. The study’s primary endpoint was the percentage of patients who had a labeled penicillin allergy that was eligible to be de-labeled after the allergy assessment interview.

Among the 62 patients who were interviewed, 15 had penicillin allergies removed from their EHRs, including four patients who were subsequently prescribed penicillin and two patients who received a cephalosporin antibiotic. Among other patients in the study population, 26 qualified for an amoxicillin oral challenge, 19 qualified for a penicillin skin test and two received no further assessment.

The researchers wrote that because many patients who were interviewed in the ED were de-labeled, their findings suggest that future research should investigate how to improve efficiency and sustainability of interdisciplinary programs in the ED to assess and de-label patients.

Editor’s note: The article was updated to clarify that of the 15 patients who were de-labeled in the study, four received penicillin.