Follow-up of penicillin allergy labels 1 year after successful penicillin delabeling

Inconsistencies in penicillin allergy labels in hospital and primary care after allergy investigation

“…Follow-up phone calls, involvement of community pharmacist or drug allergy passports have been suggested to improve communication. 5,7,8 Changes between sectors, non-standardised discharge letters as well as non-compatible electronic systems may all contribute to the relatively high number of incorrect penicillin allergy labels found in this study. A national drug allergy warning system accessible from all sectors would facilitate communication regarding correct drug allergy status and thereby improve patient safety and management.…”

“…3 Up to 50% of patients have an incorrect penicillin allergy label in the electronic medical record (EMR) after penicillin allergy investigation. 4,5 In Denmark, hospital and primary care sectors have separate, noncompatible EMR systems and there is no automatic synchronisation between systems. Information is shared through electronic letters and allergy labels are updated manually.…”

“…This study showed that there was a large mismatch between the penicillin allergy test result and the allergy label in primary care, while the mismatch was smaller between allergy test result and the hospital allergy label, also reported in another study. 5 Mismatches in the hospital EMR only concerned patients where allergy labels were not removed despite negative allergy testing (Table 2). One explanation for this could be that allergy labels are typically updated when writing the discharge letter, which might be delayed in patients still under follow-up in the department.…”

“…Overall, about one in five labels were incorrect in primary care, which although high, is lower than reported in other studies. 4,5 In our region, there is no automatic exchange of allergy label information between primary care and hospital EMR systems. The information about a disproved or confirmed penicillin allergy is instead written in free text in an electronic discharge letter to inform the GP.…”

“…Another reason for mismatch could be that the patient feels unsafe about future penicillin use, despite negative testing. 5 In such cases, to maintain a trusting doctor-patient relationship and improve antibiotic compliance the GP may choose not to remove the allergy label. An explanation for patients with three or more admissions to hospital after allergy testing having higher odds of a correct penicillin label, could be that the GP receives several discharge letters, including allergy status, or that such patients have more frequent contact to their GP.…”