Identifying and De-Labeling Inappropriate Penicillin Allergies at a Primary Care Clinic: A Student-Driven Feasibility Study
Poster #: 078
Session/Time: A
Author:
Robert Christian Busch Jr, BS
Mentor:
John E. Snellings, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Penicillin is one of the most common reported drug allergies in the U.S., though evidence shows many cases are not true IgE-mediated reactions. Mislabeling often stems from factors such as misattributing infection symptoms, over reliance on family history, or non-IgE reactions from rapid drug administration; even true IgE-mediated penicillin allergies diminish over time. All these factors contribute to worse health outcomes for patients and poor antibiotic stewardship. Recent efforts have focused on expanding penicillin allergy de-labeling initiatives into primary care settings. This student-led initiative evaluated the feasibility of primary care based de-labeling and the role of medical students in coordinating such efforts.
METHODS:
Patients with documented penicillin related antibiotic allergies were identified on the daily schedule of the EVMS Ghent Family Medicine clinic. During the visit, consenting patients completed a standardized allergy questionnaire administered by a medical student, including the PEN-FAST tool to assess risk of future IgE-mediated penicillin reactions. Patients with a score of 0 were considered very low-risk (<1%) for true penicillin allergy if their reaction was non-severe, cutaneous only, occurred over 5 years ago, and required no treatment. These patients were deemed eligible for de-labeling without further testing. Patients with PEN-FAST scores of 1-2 (<5% risk) were considered low-risk and eligible for future direct oral challenge (DOC) with amoxicillin to confirm their status.
RESULTS:
A total of 62 patients were approached, with 54 consenting to take the questionnaire (87.10%). Subjects with a very low-risk PEN-FAST score was the most common (n=20, 37.04%) followed by low-risk (n=18, 33.33%). Among those qualifying for DOC, 11 subjects expressed interest in DOC (61.11%). Logistic regression analysis showed that subject PEN-FAST score was not statistically significant as a predictor for patient openness to taking penicillin in the future (p = 0.2413). However, PEN-FAST score was a statistically significant predictor for openness to DOC, with each 1-point increase in PEN-FAST score associated with a 34% reduction in the odds of willingness to undergo DOC (OR = 0.66, 95% CI: 0.43-0.99, p = 0.0485). The overall model was significant (χ² = 4.18, df = 1, p = 0.041), indicating that higher PEN-FAST scores are linked to greater hesitancy toward DOC.
CONCLUSION:
These findings support the feasibility of a student-led penicillin allergy de-labeling initiative in a primary care setting, with 87.10% of patients consenting to participate and 61.11% of qualifying subjects open for future DOC. Furthermore, 57.41% of participants assessed with PEN-FAST were either safely de-labeled immediately or expressed willingness to undergo DOC, underscoring the potential impact of these efforts. While PEN-FAST scores stratify clinical risk, they did not consistently predict patient willingness to be open to taking penicillin. PEN-FAST scores did predict openness to DOC, however. This difference in predictability most likely is due to small sample size as this is a change from previous findings. Overall, the results demonstrate that medical students can successfully lead allergy de-labeling efforts, and a significant number of patients are willing to take the next steps, with potential for broader implementation in the future.
Penicillin is one of the most common reported drug allergies in the U.S., though evidence shows many cases are not true IgE-mediated reactions. Mislabeling often stems from factors such as misattributing infection symptoms, over reliance on family history, or non-IgE reactions from rapid drug administration; even true IgE-mediated penicillin allergies diminish over time. All these factors contribute to worse health outcomes for patients and poor antibiotic stewardship. Recent efforts have focused on expanding penicillin allergy de-labeling initiatives into primary care settings. This student-led initiative evaluated the feasibility of primary care based de-labeling and the role of medical students in coordinating such efforts.
METHODS:
Patients with documented penicillin related antibiotic allergies were identified on the daily schedule of the EVMS Ghent Family Medicine clinic. During the visit, consenting patients completed a standardized allergy questionnaire administered by a medical student, including the PEN-FAST tool to assess risk of future IgE-mediated penicillin reactions. Patients with a score of 0 were considered very low-risk (<1%) for true penicillin allergy if their reaction was non-severe, cutaneous only, occurred over 5 years ago, and required no treatment. These patients were deemed eligible for de-labeling without further testing. Patients with PEN-FAST scores of 1-2 (<5% risk) were considered low-risk and eligible for future direct oral challenge (DOC) with amoxicillin to confirm their status.
RESULTS:
A total of 62 patients were approached, with 54 consenting to take the questionnaire (87.10%). Subjects with a very low-risk PEN-FAST score was the most common (n=20, 37.04%) followed by low-risk (n=18, 33.33%). Among those qualifying for DOC, 11 subjects expressed interest in DOC (61.11%). Logistic regression analysis showed that subject PEN-FAST score was not statistically significant as a predictor for patient openness to taking penicillin in the future (p = 0.2413). However, PEN-FAST score was a statistically significant predictor for openness to DOC, with each 1-point increase in PEN-FAST score associated with a 34% reduction in the odds of willingness to undergo DOC (OR = 0.66, 95% CI: 0.43-0.99, p = 0.0485). The overall model was significant (χ² = 4.18, df = 1, p = 0.041), indicating that higher PEN-FAST scores are linked to greater hesitancy toward DOC.
CONCLUSION:
These findings support the feasibility of a student-led penicillin allergy de-labeling initiative in a primary care setting, with 87.10% of patients consenting to participate and 61.11% of qualifying subjects open for future DOC. Furthermore, 57.41% of participants assessed with PEN-FAST were either safely de-labeled immediately or expressed willingness to undergo DOC, underscoring the potential impact of these efforts. While PEN-FAST scores stratify clinical risk, they did not consistently predict patient willingness to be open to taking penicillin. PEN-FAST scores did predict openness to DOC, however. This difference in predictability most likely is due to small sample size as this is a change from previous findings. Overall, the results demonstrate that medical students can successfully lead allergy de-labeling efforts, and a significant number of patients are willing to take the next steps, with potential for broader implementation in the future.