ArticleThe journal of allergy and clinical immunology. In practice
The Cost of Penicillin Allergy Evaluation.
Article in The journal of allergy and clinical immunology. In practice. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
49 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Quality and Consistency of Penicillin Allergy Delabelling Guidelines: A Systematic Review.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026Pooled it
- Time-Driven Activity-Based Costing and Its Use in Health Economic Analysis: A Systematic Literature Review.Applied health economics and health policy · 2025Pooled it
- The cost-effectiveness of penicillin allergy testing: Evidence and gaps from a systematic review.PloS one · 2025Pooled it
- Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline.Clinical reviews in allergy & immunology · 2024Pooled it
- Trial
- Infection-embedded penicillin allergy de-labelling delivers immediate antimicrobial stewardship gains in patients with active infection.JAC-antimicrobial resistance · 2026Article
- Amoxicillin Direct Oral Challenge in Hospitalized Patients With High-Risk Allergic Reactions, in a Pharmacist-Directed Program.Open forum infectious diseases · 2026Article
- A call to action for penicillin allergy delabeling in patients with syphilis.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025Article
- Direct oral challenges safely reduce the burden of low-risk cephalosporin allergy labels.The journal of allergy and clinical immunology. In practice · 2025Article
- Proactive Penicillin Allergy Delabeling: Lessons Learned From a Quality Improvement Project.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2025Article
- Building an allergy reconciliation module to eliminate allergy discrepancies in electronic health records.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Drug allergy.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Review
- Impact of beta-lactam allergy labels on bone marrow transplant patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Antibiotic use and financial impact of a comprehensive beta-lactam allergy management program.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Patient-related factors impact the implementation of inpatient antibiotic allergy delabeling.The journal of allergy and clinical immunology. Global · 2024Article
- How to Define and Manage Low-Risk Drug Allergy Labels.The journal of allergy and clinical immunology. In practice · 2024Review
- Resource utilization and cost assessment of a proactive penicillin allergy de-labeling program for low-risk inpatients.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024Article
- Penicillin allergy delabeling: Opportunities for implementation and dissemination.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2023Review
- Cost of Serum Versus Skin Allergy Testing Among Medicare Fee-for-Service Beneficiaries in the United States.Journal of health economics and outcomes research · 2023Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundUnverified penicillin allergy leads to adverse downstream clinical and economic sequelae. Penicillin allergy evaluation can be used to identify true, IgE-mediated allergy.
objectiveTo estimate the cost of penicillin allergy evaluation using time-driven activity-based costing (TDABC).
methodsWe implemented TDABC throughout the care pathway for 30 outpatients presenting for penicillin allergy evaluation. The base-case evaluation included penicillin skin testing and a 1-step amoxicillin drug challenge, performed by an allergist. We varied assumptions about the provider type, clinical setting, procedure type, and personnel timing.
resultsThe base-case penicillin allergy evaluation costs $220 in 2016 US dollars: $98 for personnel, $119 for consumables, and $3 for space. In sensitivity analyses, lower cost estimates were achieved when only a drug challenge was performed (ie, no skin test, $84) and a nurse practitioner provider was used ($170). Adjusting for the probability of anaphylaxis did not result in a changed estimate ($220); although other analyses led to modest changes in the TDABC estimate ($214-$246), higher estimates were identified with changing to a low-demand practice setting ($268), a 50% increase in personnel times ($269), and including clinician documentation time ($288). In a least/most costly scenario analyses, the lowest TDABC estimate was $40 and the highest was $537.
conclusionsUsing TDABC, penicillin allergy evaluation costs $220; even with varied assumptions adjusting for operational challenges, clinical setting, and expanded testing, penicillin allergy evaluation still costs only about $540. This modest investment may be offset for patients treated with costly alternative antibiotics that also may result in adverse consequences.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.