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Penicillin allergy is noted in the records of more than 10% of the U.S. population; however, most patients have either “outgrown” their allergy or actually experienced viral rash or nonimmunological adverse reactions such as diarrhea. Penicillin allergy is associated with patients receiving more-expensive, less-effective, and more-toxic antibiotics (NEJM JW Gen Med Aug 1 2020 and JAMA Intern Med 2020; 180:1120). Several studies published during the past year inform efforts to “delabel” patients who are incorrectly labeled as penicillin allergic.
Penicillin skin testing has a very good negative predictive value, but it is not widely available and has a high false-positive rate. In low-risk patients, observed oral challenge is a safe alternati…