What question did this study set out to answer?

To evaluate the effectiveness and challenges of penicillin allergy de-labeling in elderly hospitalized patients.

February 12, 2026Open Access

PEN-DEL: implementing penicillin allergy de-labeling in hospitalized older adults – a quality improvement initiative

Key Points

To evaluate the effectiveness and challenges of penicillin allergy de-labeling in elderly hospitalized patients.
Conducted a quality improvement study from March 2024 to April 2025.
Screened and assessed hospitalized patients aged 65 and older with a penicillin allergy.
Utilized PEN-FAST score and clinical judgment for eligibility in de-labeling.
Documented outcomes after penicillin challenges and gathered staff feedback on barriers.
87 patients met the inclusion criteria from an initial screening of 105.
71% of eligible patients were successfully de-labeled from penicillin allergies.
42% of patients received beta-lactam antibiotics within four weeks after de-labeling.
Only 1 patient experienced a delayed reaction to amoxicillin-clavulanate.

Abstract

Abstract Background: Erroneously labeled penicillin allergies can lead to prolonged hospitalization, increased adverse effects and infection rates with alternative antibiotics. Although elderly patients are more vulnerable to these negative outcomes, penicillin allergy assessments and de-labeling remain underutilized in this population. Objective: To assess the efficacy and challenges of implementing penicillin allergy de-labeling in hospitalized elderly patients. Methods: Between March 2024 and April 2025, we conducted a quality improvement study on patients who were 65 years and older, had a penicillin allergy, and were admitted to Burnaby Hospital Acute Care for Elderly (ACE) Unit. Patients were proactively screened, interviewed, and assessed for eligibility in allergy de-labeling based on PEN-FAST score ≤1, predefined criteria, clinical judgment, and patient consent. If penicillin challenge was given, patients received pharmacist follow-up and 4-week outcomes were documented. A post-implementation survey was distributed to ward healthcare staff to identify barriers to implementation. Results: Out of 105 patients screened, 87 patients met study inclusion criteria. Among 34 patients deemed eligible for de-labeling, 24 patients (71%) were de-labeled from either oral amoxicillin challenge or information gathering alone. Within four weeks after de-labeling, 10 patients (42%) received beta-lactam antibiotics, and no patients received guideline-discordant broad-spectrum antibiotics. Only 1 patient experienced a delayed reaction to amoxicillin-clavulanate. From surveying ACE unit nursing, physician, and pharmacy staff, frequently reported barriers to allergy assessment and de-labeling included time and staffing constraints, and patient complexity. Conclusions: Our pharmacy-driven interdisciplinary penicillin allergy de-labeling initiative is effective and safe for eligible hospitalized older adults with low PEN-FAST scores (≤1).

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