Penicillin Allergy Delabeling – Pilot for PHM Patients

Note: This clinical pathway is currently a pilot for Pediatric Hospital Medicine (PHM) patients at CT Children’s. 

Pathway Background and Objectives

Inappropriate penicillin allergy labels are very common. Carrying a penicillin allergy label can result in use of overly broad spectrum antibiotics which is associated with a variety of negative outcomes. New national practice parameters emphasize the need to proactively identify false allergy labels and remove (delabel) them. A direct oral challenge with amoxicillin is safe and effective in testing patients who are at a low risk of having a true, IgE-mediated reaction. There is limited access to allergists nationwide. This pathway empowers all healthcare providers to safely delabel penicillin, allowing more patients access to this important care.

The objectives of this pathway are to: 

  • Standardize the process for identifying patients with low risk of true penicillin allergy
  • Standardize the process for delabeling low-risk penicillin allergies in the inpatient setting
     

Algorithm  Educational Module    Family Handout

  • Percentage of order set usage
  • Percentage of patients with an allergy with whom penicillin challenge is discussed
  • Percentage of patients with discussion about delabeling that undergo challenge
  • Percentage of patients challenged who are discharged on penicillin-class antibiotics
  • Review of severity of reaction (if present)
  • Percentage of challenged patients with documentation in the discharge note
  • Percentage of patients with allergy appropriately delabeled in the allergy section of the chart
  • Service that performed challenge
     

Khan DA, Banerji A, Blumenthal KG, Phillips EJ, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022 Dec;150(6):1333-1393. 

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.