Complex Problem, Digital Cure? Rethinking Penicillin Allergy Relabeling Using Technology-Enabled Care

Le résumé fourni par la source

To The Editor—We thank Witt et al for their letter [1] and interest in our review of integrated multidisciplinary approaches to antibiotic allergy care [2]. While the electronic health record (EHR) has revolutionized patient care, its implementation has introduced barriers to effective antibiotic allergy management. We fully support the view that beta-lactam cross-reactivity alerts embedded in the EHR are outdated and do not align with modern prescribing practices. System-wide deactivation of such alerts represents a low-complexity, high-impact antimicrobial stewardship strategy that would facilitate optimal antibiotic prescribing, without a corresponding increase in adverse events [3, 4]. However, careful consideration is required to document uniform EHR recommendations for beta-lactam avoidance in the rare subset of patients with beta-lactam-induced severe cutaneous adverse reactions. Relabeling rates following antibiotic allergy testing vary in the literature yet remain a significant barrier to the longer-term sustainability of delabeling efforts. We reviewed the 12-month relabeling rates among participants in the International Network of Antibiotic Allergy Nations (iNAAN) cohort, an international prospective study examining multidisciplinary-led inpatient penicillin direct oral challenge (DOC) in 40 hospitals across 8 countries [5]. Between 9 November 2022 and 18 December 2024, 3965 participants underwent penicillin allergy assessment, of which 1832 (46.2%) were delabeled, 1140 (62.2%) following DOC, and 692 (37.8%) directly delabeled following medical reconciliation alone. Of 1296 (70.7%) participants with completed 12-month follow-up, 81 (6.3%) had their penicillin allergy label reinstated in their local hospital medical record within 1 year. Inadvertent relabeling, a patient- or clinician-reapplied penicillin allergy label in the absence of a new reaction, accounted for 55 (68%) of relabeling events. Relabeling secondary to a new or de novo penicillin reaction following a negative DOC or prior demonstrated tolerance of penicillin occurred in 24 (29.6%) of relabeled participants (Table 1).

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