Lessons Learned: Approaches to Delabeling Penicillin Allergy-A Clinical Management Review of Population-Level Strategies.

Abstract

Penicillin allergy labels are a major barrier to optimal antimicrobial stewardship, yet most reported reactions are inaccurate and can be safely removed after evaluation. This Clinical Management Review article summarizes lessons from population-level delabeling initiatives, highlighting the value of incorporating nonallergist perspectives and practical implementation tools. Effective strategies extend beyond specialist settings and rely on multidisciplinary engagement-including primary care, pharmacy, and nursing-to scale interventions. A practical toolkit offering standardized risk-stratification algorithms, oral challenge protocols, and communication templates supports safe and efficient delabeling across diverse clinical environments. Psychosocial and equity considerations are critical to delabeling success. Fear, misinformation, and cultural beliefs often shape patients' willingness to undergo evaluation, while systemic barriers-such as limited specialist access, language differences, and resource constraints-contribute to disparities. Programs that embed patient-centered education, shared decision making, and flexible delivery models show improved uptake and long-term sustainability. Equity-focused approaches, including outreach to underserved communities and integration into routine care pathways, are essential to achieving broad impact. By combining evidence-based protocols with practical tools and inclusive stakeholder engagement, health systems can overcome logistical and psychosocial challenges to meaningfully reduce the number of inappropriate penicillin allergy labels. These lessons underscore the need for adaptable, equity-driven strategies to optimize antimicrobial use and improve patient outcomes.