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Inaccurate Penicillin Allergy Labeling, the Electronic Health Record, and Adverse Outcomes of Care

      In this era of increasing resistance to antimicrobial medications, the problem of clinically inaccurate penicillin antibiotic allergy labeling is acknowledged and well documented. More than 30 million people in the United States alone are characterized in their medical records as allergic to penicillin.
      • Shenoy ES
      • et al.
      Evaluation and management of penicillin allergy: a review.
      Yet published data from numerous centers worldwide repeatedly document that more than 90% of such individuals can tolerate penicillin and other beta-lactam antibiotics without adverse reactions.
      • Shenoy ES
      • et al.
      Evaluation and management of penicillin allergy: a review.
      A recent review of the topic of penicillin allergy and the appropriate use of beta-lactam antibiotics was commissioned by the American Academy of Allergy, Asthma & Immunology (AAAAI), the Infectious Diseases Society of America (IDSA), and the Society for Healthcare Epidemiology of America (SHEA).
      • Shenoy ES
      • et al.
      Evaluation and management of penicillin allergy: a review.
      That review describes the extent of the problem of penicillin allergy mislabeling and delineates the negative sequelae of the avoidance of beta-lactam antibiotics both on individual patient outcomes and on the public's health. Some of those adverse consequences include worse medical outcomes, including mortality in staphylococcal
      • Blumenthal KG
      • et al.
      Improving clinical outcomes in patients with methicillin-sensitive Staphylococcus aureus bacteremia and reported penicillin allergy.
      and gram-negative septicemia,
      • Jeffres MN
      • et al.
      Consequences of avoiding ß-lactams in patients with ß-lactam allergies.
      increased postoperative surgical infections,
      • Blumenthal KG
      • et al.
      The impact of a reported penicillin allergy on surgical site infection risk.
      more treatment failures in immunocompromised patients,
      • Huang KHG
      • et al.
      The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics.
      and increased selection of drug-resistant pathogens, including methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection.
      • Macy E
      • Contreras R.
      Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study.
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