JAC Antimicrob Resist. 2026 Apr 7;8(2):dlag033. doi: 10.1093/jacamr/dlag033. eCollection 2026 Apr.
ABSTRACT
BACKGROUND: Unverified drug allergies pose a significant barrier to successful antimicrobial stewardship efforts. Most delabelling efforts to date have occurred within an inpatient setting or through outpatient evaluations with an allergy specialist; limited data exist examining β-lactam allergies and delabelling efforts among diverse and underserved populations. Strategies are needed to better identify priority populations for allergy delabelling efforts and the highest-yield opportunities for intervention.
OBJECTIVES: We aimed to evaluate the prevalence of penicillin allergy labels (PALs) or cephalosporin allergy labels (CALs) among patients receiving infectious diseases (ID) specialty care across multiple academic and community-based settings and to characterize reported reactions and referral patterns to allergy specialists.
METHODS: We conducted a cross-sectional, retrospective cohort study of patients with PAL or CAL receiving care within seven outpatient specialty ID clinics and five inpatient ID consultation services within a large health system between 1 April 2021 and 31 December 2024.
PATIENTS: Inclusion criteria for this study were patients >18 years old with a PAL or CAL listed in the electronic health record who received care at one of the above described clinics during the study time frame.
RESULTS: Among 4951 patients with a reported PAL or CAL, most were male (56%; n = 2754), non-Hispanic (86%; n = 4242) and white race (53%; n = 2623), with a mean age of 48.2 years. PAL and CAL rates were 7.6%-16.7% and 1.1%-5.3%, respectively, in outpatient ID clinics, and 8.8%-15.5% and 3.9%-6.1%, respectively, on inpatient ID consultation services. Of a total of 5965 PAL and 1506 CAL reported entries, most were consistent with hypersensitivity reactions (62.9% and 63.8%, respectively). There were 41.6% of patients with a PAL and 47.7% of patients with a CAL who reported isolated cutaneous symptoms only (flushing, itching, rash or urticaria). Few patients were referred to allergy specialists (7.8%) and ultimately delabelled.
CONCLUSIONS: High rates of penicillin and cephalosporin allergy labels, the majority of which reflect low-risk reactions, demonstrate a real ongoing need for innovative strategies to maximize delabelling efforts for patients with unverified drug allergies and infectious care needs.
PMID:41959697 | PMC:PMC13061342 | DOI:10.1093/jacamr/dlag033