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The American Academy of Allergy, Asthma & Immunology (AAAAI) is “encouraging widespread and routine penicillin allergy evaluations” for patients who have the allergy listed in their medical records but who are not truly allergic or have outgrown the allergy….. 34 February 2024 Inhalation BACK PAGE Penicillin allergy: Removing inaccurate medical record labeling for patients who are not truly allergic or no longer allergic e American Academy of Allergy, Asthma & Immunol- ogy (AAAAI) is "encouraging widespread and routine penicil- lin allergy evaluations" for patients who have the allergy listed in their medical records but who are not truly allergic or have outgrown the allergy. In a position statement, the AAAAI noted that "10% of the [United States} population, and up to 15% of hospitalized patients, are labeled with a pen- icillin allergy. However, when a penicillin allergy evaluation is performed in those patients who report a history of penicillin allergy, the overwhelming major- ity tolerate penicillins and thus, the allergy label can be removed, and the patient can be 'delabeled.'" e AAAAI cited multiple reasons for the low rate of confirmed pen- icillin allergy, including: • mislabeling of a side effect as an allergy (e.g., gastrointestinal upset); • a coincidental event (e.g., head- ache or cutaneous eruption due to underlying infection); • reduced rates of exposure to parenteral penicillins; and • loss of sensitization with avoid- ance of penicillins over time. e AAAAI also explained that "poor patient outcomes are associ- ated with penicillin allergy." ese outcomes include "increased hospi- tal length of stay, increased periop- erative infections, and overall increased mortality." In addition, the use of alternative antibiot- ics can be "associated with higher costs (due to use of more expensive broad-spectrum antibiotics), infe- rior efficacy and/or greater risk for untoward effects including antibi- otic resistance, Clostridium difficile, and side effects." At the same time, the AAAAI noted that "penicillin allergy testing has a very favorable cost- benefit ratio for the incremen- tal cost of testing versus future health care utilization." e AAAAI also stated that "dela- beling penicillin allergy is an important component of antibi- otic stewardship and is endorsed by many professional organiza- tions and public health bodies." In addition, the position state- ment included guidance for phy- sicians in conducting penicillin allergy evaluations in patients. Examples of delabeling programs According to the Pittsburgh Post- Gazette, allergists at the Uni- versity of Pittsburgh Medical Center (UPMC) Children's Hos- pital have been evaluating inpa- tients to determine if they can be cleared of penicillin allergies in their medical records. "Since 2020, among 60,248 patients, nearly 6% had been labeled with a penicillin allergy," said Chris- tin Deal, a UPMC allergist. "rough the inpatient initia- tive, allergists have been able to remove the penicillin label from 16-19% of those patients." In addition, a pilot program at UPMC Children's Community Pediatrics is allowing pediatricians to give allergy tests to patients