1 in 5 penicillin allergy labels still incorrect after investigation

Key takeaways:

• Many penicillin allergy labels did not match in hospitals and primary care clinics in Denmark.
• Researchers advocated for greater communication and follow-up efforts.

More than 20% of patients whose penicillin allergy was disproved in a hospital allergy clinic still had an inaccurate penicillin allergy label in their primary care clinic, revealing a lack of communication between providers, a study found.

According to Sara Fransson, MD, from the department of dermatology and allergy at Copenhagen University Hospital in Denmark, and colleagues, “up to 50% of patients have an incorrect penicillin allergy label in the electronic medical record (EMR) after penicillin allergy investigation.”

“If labels are not correctly updated, patients with confirmed allergy may be at risk of subsequent severe allergic reactions and patients where allergy is disproved might receive suboptimal treatment potentially leading to longer hospital admissions and increased risk of acquiring antibiotic-resistant infections,” the researchers wrote in Clinical and Experimental Allergy.

For the study, Fransson and colleagues investigated how often penicillin allergy labels matched in hospital and primary care EMR systems. The final analysis included 511 Danish patients who underwent a penicillin allergy investigation at a hospital allergy clinic between 2017 to 2019. The patients had a mean age of 50 years. Among them, a penicillin allergy was confirmed in 77 patients and disproved in 434 patients.

The researchers found that all 77 patients with a confirmed penicillin allergy were correctly labeled within the hospital EMR. Among patients with a disproved allergy, 29 still had an incorrect allergy label in the hospital EMR, and of that group, 16 also had an incorrect label in their primary care clinic.

Overall, among patients with a disproved allergy, 21.4% still had an incorrect penicillin allergy label in their primary care clinic. Meanwhile, a penicillin allergy label was missing in primary care clinics for 26% of patients with confirmed allergies.

Fransson and colleagues also reported that the odds of having a mismatch in the primary care clinic were lower for men (OR = 0.52; 95% CI, 0.29-0.88) and those with three or more hospital admissions since allergy testing (OR = 0.31; 95% CI, 0.09-0.82).

“Improvements in communication between health care sectors are necessary,” Fransson and colleagues wrote. “Follow-up phone calls, involvement of community pharmacist or drug allergy passports have been suggested to improve communication.”

They concluded a national drug allergy warning system accessible from all health sectors “would facilitate communication regarding correct drug allergy status and thereby improve patient safety and management.”