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How Far Are We From Achieving Delabeling of False Penicillin/b-Lactam Allergy Alerts? A Population Problem

Tejedor-Alonso MA1,2, Perez-Encinas M3, Sanz Márquez S3, Martinez Simon JJ3, Moreno-Nuñez L4, Gonzalez-Moreno A1, Macias-Iglesias J1, Rosado-Ingelmo A1,5

1Allergy Unit, University Hospital Fundación Alcorcon, Alcorcón, Spain
2Facultad Ciencias de la Salud, Department Public Health and Medical Specialties, Universidad Rey Juan Carlos, Alcorcón, Spain
3Pharmacy Area, University Hospital Fundacion Alcorcón, Alcorcón, Spain
4Infectious Diseases Unit, University Hospital Fundación Alcorcón, Alcorcón, Spain
5International Doctoral School, Faculty of Health Sciencies Ciencias de la Salud, University Rey Juan Carlos, Alcorcón, Spain

J Investig Allergol Clin Immunol 2025; Vol. 35(1)
doi: 10.18176/jiaci.1004

Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non–ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less “ultrarapid” strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

Key words: Penicillin, ß-Lactam, Allergy, Label, Barriers, Effectiveness