Drug allergy delabeling in the clinical setting: An all-hands-on-deck opportunity

Abstract

Drug allergy delabeling refers to the removal of a listed drug from the allergy section. In an ideal scenario, the removal of the patient allergy label is then communicated in a streamlined process to the patient and their health care settings. The future of large-scale drug allergy delabeling rests on multiple factors: culture shifts, easily adapted tools to delabel our largest drug allergy categories, and electronic health record (EHR) crosstalk. The present functionalities of most EHR allergy sections and ignorance of their content are at odds with our universal goals of providing highly reliable, expert, safe, and affordable care. In a previous study from our health care system, more than 35% of patients had at least 1 listed drug allergy in their EHR. 1 Zhou L. Dhopeshwarkar N. Blumenthal K.G. et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy. 2016; 71: 1305-1313 Crossref PubMed Scopus (152) Google Scholar In our practice at Brigham and Women’s Hospital, we have manually reviewed patients’ charts with more than 20 listed drug allergies, and it was clear that no one took the time to look at the complete list, remove duplicates, or ask a reaction history to any listed agent. Frequently, the drug allergy list is not as daunting, but it still lists an “unknown” reaction or an inaccurate medication, despite the fact that the patient is able to clearly articulate the drug allergy history. The documentation of these drug allergies has real implications for safe prescribing, longer hospital admissions, and hospital-associated infections. 2 Macy E. Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014; 133: 790-796 Abstract Full Text Full Text PDF PubMed Scopus (507) Google Scholar