Proactive Penicillin Allergy Delabeling: Lessons Learned From a Quality Improvement Project.

Background: About 9% of all patients have a health record indicating penicillin allergy, but only 10% of these patients are truly allergic on confirmatory testing. This high percentage of incorrect labeling creates a burden for the health care system and patients, making the removal of this diagnosis an important priority. Until recently, penicillin delabeling has been done primarily by allergists, but integration with primary care is needed. Observations: A program was developed that successfully trained primary care practitioners (PCPs) to use the PEN-FAST clinical criteria to identify low-risk patients and conduct an oral test for allergy. This model allows low-risk patients to undergo testing in a primary care office with resources available to treat any immunoglobulin E mediated severe reaction. Patients who test negative for a penicillin allergy can then be delabeled and receive more appropriate antibiotics during future infections. Skin testing was only used in 18% of the tested population and 94% of tested patients tolerated the antibiotic and their penicillin allergy history was delabeled. Conclusions: In this program most penicillin allergy labels were cleared based on clinical criteria and oral challenge alone, highlighting the potential benefits of PEN-FAST. Expansion of training should be offered to PCPs to conduct oral challenges in appropriate settings in an effort to reduce this significant burden on patient care.