Amoxicillin Direct Oral Challenge in Hospitalized Patients with High-Risk Allergic Reactions, in a pharmacist directed program

In 169 hospitalized adults with penicillin allergy histories, either through interview or listed in the electronic medical record of urticaria, angioedema, anaphylaxis, and shortness of breath at least 10 years ago, 94.1% tolerated a direct oral amoxicillin challenge led by a non-allergy specialist and were de-labeled. Mild reactions occurred in 5.9%, with no severe events. This safe, effective approach may improve antibiotic stewardship, reduce costs, and support broader implementation over penicillin skin testing.