ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 69 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Penicillin Allergy Delabeling After a One-Dose Versus Two-Dose Graded Direct Oral Challenge
Optimization of Antibiotic Treatment in Patients With a Reported Penicillin Allergy Using a Digital Clinical Decision Support Tool.
Who cites it
69 citing papers in PubMed, 5 syntheses or guidelines pooled it, 169 citations in OpenAlex.
- Pooled it
- A systematic review and meta-analysis of interventions to delabel low-risk penicillin allergies with consideration for sex and gender.British journal of clinical pharmacology · 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
- The effectiveness of interventions that support penicillin allergy assessment and delabeling of adult and pediatric patients by nonallergy specialists: a systematic review and meta-analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Pooled it
- Oral challenge vs routine care to assess low-risk penicillin allergy in critically ill hospital patients (ORACLE): a pilot safety and feasibility randomised controlled trial.Intensive care medicine · 2024Trial
- Guidelines for the management of adult penicillin allergy in community and specialist settings in Australia and New Zealand: An AGREE II and Delphi-based approach.The journal of allergy and clinical immunology. Global · 2026Article
- Penicillin allergy delabeling in a German University Hospital-implementation in inpatient settings: the PenGuin Pilot Study.Infection · 2026Article
- Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- Outcomes of a penicillin allergy de-labelling implementation intervention in a UK hospital: a prospective, single centre, type 2 hybrid effectiveness-implementation study evaluated using mixed methods.Implementation science communications · 2026Article
- Negative Test, Persistent Avoidance: Real-World Outcomes of Quinolone De-Labeling.Journal of clinical medicine · 2026Article
- Clinical Outcome Associated With Beta-Lactam Allergy Labels in Hospitalized Patients in Belgium.Clinical and translational allergy · 2026Article
- Impact Assessment of the Allergy Fact Checker, a Clinical Decision Support Tool for Noninvasive Beta-Lactam Antibiotic Allergy Label Delabeling: Protocol for a Multicenter Crossover Cluster-Controlled Study.JMIR research protocols · 2026Article
- Impact of beta-lactam allergy labels on antibiotic prophylaxis and surgical site infections after cesarean section; a retrospective study.Antimicrobial resistance and infection control · 2026Article
- Inpatient direct oral challenge for sulfa antibiotic allergy: improving care in immunocompromised hosts.Infection control and hospital epidemiology · 2026Article
- Sex-based differences in penicillin allergy labeling among adults in a Canadian ambulatory urgent medicine clinic: a cross-sectional study.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- PEN-DEL: implementing penicillin allergy de-labeling in hospitalized older adults - a quality improvement initiative.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Penicillin allergy documentation in the UAE: 10-year trends and stewardship implications.Frontiers in medicine · 2026Article
- Global Burden of Drug-Induced Anaphylaxis Associated With 33 Classes of Antibiotics (1968-2024): A Pharmacovigilance Analysis.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Article
- Evaluation of the Allergy Fact Checker, a clinical decision support system for non-invasive beta-lactam delabeling: a mixed-methods study.NPJ digital medicine · 2025Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundPenicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients.
methodsPatients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days).
resultsBetween 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39-20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45-3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27-.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09-23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94-11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36-.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26-.72]) in the delabeled group compared with the group who retained their allergy label.
conclusionsThis health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.
Indexed as
Identifiers
What OpenQuestion holds
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.