Problems With Electronic Health Record Penicillin Allergy Mislabeling and Recommendations for Their Correction

To the Editor—We read with interest the excellent review by Mitri et al [1] The author's propose excellent guidance for penicillin allergy delabeling. They acknowledge that allergists are in short supply and not available in most hospitals and propose broadening the delabeling process to recruit those performing antibiotic stewardship, infectious disease physicians, and pharmacists. This proposal, however, is problematic within the majority of hospitals and out-patient settings. In the United States, 82% of counties have no allergists, and 79.5% have no infectious disease physician [2, 3]. The authors do not discuss one critical cause of the delabeling problem and its potential correction. The electronic health record (EHR), as currently configured, posts a “safety” alert when any beta-lactam antibiotic is ordered for patients with a recorded intolerance to any beta-lactam. This occurs if the “allergy” is zero risk or a nonallergic event such as nausea happens, even if beta-lactam challenge is documented [4]. The EHR gives a veneer of diagnostic validity perpetuating inaccurate penicillin allergy mislabeling [5]. Unlike the durable delabeling of the PALACE study [6], several publications document subsequent relabeling [7–10].