Incidence of interruptive penicillin allergy alerts in patients with previously documented beta-lactam exposure: Potential for leveraging the electronic health record to identify erroneous allergies

Background: Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non-beta-lactam antibiotics that are typically broader spectrum and more toxic. Orders for beta-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior beta-lactam exposure. Objective: To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a beta-lactam exposure. Design: Retrospective EHR review from January 2013 through June 2018. Setting: A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and similar to 250 outpatient clinics. Participants: All patients with EHR-documented of penicillin allergies. Methods: We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other beta-lactam antibiotic. Results: Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any beta-lactam. Conclusions: Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another beta-lactam.

Automated summary

The study found that many patients who received interruptive penicillin allergy alerts would likely tolerate penicillin, and half of the alerts were displayed for patients who would likely tolerate another beta-lactam antibiotic.