Removing inaccurate penicillin-allergy labels may improve antibiotic care

Published October 28, 2026 · Systematic review of nine comparative studies · Actionable within structured hospital pathways Primary source: Hospital penicillin delabeling systematic review, PMID 42946949

Many hospitalized patients carry a penicillin-allergy label that does not reflect a true clinically relevant allergy. A new systematic review examined nine controlled studies—three randomized trials and six nonrandomized studies—of structured delabeling interventions.

Reported delabeling success ranged from approximately 4% to more than 95%, largely because methods and case selection differed. Carefully selected low-risk patients undergoing direct oral challenge were among the most successfully delabeled. Pharmacistand antimicrobial-stewardship-led programs also identified inaccurate labels and supported more appropriate narrow-spectrum antibiotic use. Adverse events were uncommon and predominantly mild in the included studies.

Strength and limitations. The intervention is practical, but the extreme range is a warning against quoting a universal success rate. Heterogeneous protocols, risk definitions, designs, and outcomes prevented meaningful pooling. Structured allergy history and supervised challenges are not equivalent to telling patients to ignore reported reactions.

Clinical practice: A credible near-term clinical implementation candidate where trained personnel, clear exclusions, documentation, and rescue procedures exist.