Safety, Efficacy, and Effectiveness of Delabeling in Patients with Multiple Drug Allergy Labels

Abstract

Patients with multiple drug allergy labels (MDALs) present a challenging barrier to patient care. To assess the efficacy, safety, and effectiveness of removing MDALs in a single clinic visit. Retrospective chart review was performed from October 1, 2014, to October 31, 2018, on patients with MDALs who had electronic health record (EHR) allergy label to 2 or more drugs and who were delabeled to 1 or more drug. Our primary outcome was the number of allergy labels tested and removed, at a single or multiple visits. Postvisit surveys were administered to patients, their pharmacies, and primary care physicians for patients delabeled following an EHR transition from November 2, 2017, to October 31, 2018 (n= 184). Among 536 patients meeting inclusion criteria, 916 of 943 (97.1%) tested allergy labels were removed from the EHR. Most patients, 461 of 536 (86.0%), were tested, challenged, and delabeled in a single visit, to 1 or more drug, although 134 of 536 (25%) still had evidence of 1 or more label at 1 year. In surveys, 90 of 171 (52.6%) responding pharmacies and 122 of 168 (72.6%) primary care physicians contacted had removed drug labels from the EHR as a result of the recommendations from the patient's drug allergy evaluation. Overall, 91 of 142 (64.1%) MDAL patient survey respondents were willing to take the drugs to which they had been delabeled. Patients with MDALs can be safely delabeled to multiple drugs in 1 visit; however, effectiveness barriers were identified. Reinforcement of drug allergy label removal information to patients, pharmacies, and primary care providers presents a targeted area for improvement.