De-labeled penicillin allergies often persist in pharmacy records

SAN ANTONIO — Nearly one-third of patients who had de-labeled penicillin allergies still had such labels listed at their pharmacy, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Such discrepancies signal that obstacles for de-labeling remain, despite having an effective de-labeling program, according to the researchers.

Because some labeled allergies may not be reassessed following diagnosis, “it’s important to assess if patients who carry a penicillin allergy label are truly still allergic to penicillin,” Althea Marie Diaz, MD, an allergist-immunologist at NYU Langone Long Island Hospital, said during her abstract presentation.

Past research has also associated penicillin labeling with several adverse health outcomes. For instance, in a study published last year in The Journal of Allergy and Clinical Immunology: In Practice, Kaminsky and colleagues found that patients with bacterial pneumonia and penicillin labels had higher risks of hospitalization, intubation and mortality.

Additionally, “patients are started on broader spectrum antibiotics, which carries an increased risk for antibiotic resistance,” Diaz said.

The researchers conducted a retrospective study using the charts of 78 patients, aged 11 years and older, who were de-labeled of their penicillin allergies based on negative skin testing and aminopenicillin oral challenges between May 2019 and May 2022.

Participating patients had their penicillin allergy removed from the clinic’s electronic medical record and received a wallet card indicating results. Researchers also delivered a confirmation receipt to both the patients’ primary care physician and pharmacists.

Overall, 68 patients completed follow-up interviews the researchers conducted to determine de-labeling outcomes. Although 99% of the total 78 patient charts were de-labeled in the EMR, 31% still had an active penicillin allergy listed at their pharmacy.

The researchers found that 97% of interviewed patients correctly recalled now having a negative penicillin allergy result, with 44% having taken penicillin since de-labeling. Despite the negative result, 6% avoided penicillin and 4% reported unknown antibiotic use.

“[The study] demonstrates that our penicillin de-labeling protocol is effective for patients to recall that they are not penicillin allergic,” Diaz concluded during the presentation. “However, the discrepancy in allergic status between EMR and patient pharmacies exemplifies the need to identify barriers in universally de-labeling patients.”

References:

• Kaminsky LW, et al. J Allergy Clin Immunol Pract. 2022;doi:10.1016/j.jaip.2022.08.027.
• Following patient penicillin allergy de-labeling, pharmacy records aren’t always updated to reflect changes. https://www.aaaai.org/About/News/News/2023/penicillin. Published Feb. 3, 2023. Accessed Feb. 17, 2023.