De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.

Cohort studyThe western journal of emergency medicine· Jun 2026

De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.

Brian Chen, Phuong Khanh T Nguyen, My-Phuong Pham … Christopher J Graber

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Allergy & ImmunologyCohort studyClinical practiceQ2IF 2.2

Only 0.7% of patients reacted to the in-emergency department oral amoxicillin challenge.

De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.

Brian Chen … Christopher J Graber

The western journal of emergency medicine · Jun 2026 · Q2 in General Medicine

Background

Penicillin allergy is one of the most reported drug allergies, but studies have shown that patients who report an allergy frequently do not have a significant reaction when challenged.

Methods

With low-risk allergy histories who were to be admitted and gave formal consent were given an oral amoxicillin challenge and then observed in the emergency department for at least one hour.

n = 144 patients

0.7%

Results

0.7%

Just 1 of 144 patients had a mild reaction to the amoxicillin challenge.

n = 144 patients

More results

A total of 144 patients received an allergy assessment in the emergency department, 20 who received an oral amoxicillin challenge and 124 who did not.

Baseline characteristics were similar in both groups.

More results

The average total LOS in the oral amoxicillin-challenged patients was a non-significant 36 minutes longer compared to the non-challenged patients (P = 0.4).

Of 144 patients, 71 (49%) had their penicillin allergy removed as a result of the challenge..

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Conclusion · 1 of 3

An emergency department pharmacist-led, penicillin de-labeling protocol was safe and feasible.

Conclusion · 2 of 3

A secondary exploratory analysis showed no significant difference in length of stay between patients who received the oral amoxicillin challenge in the emergency department vs those who did not.

Conclusion · 3 of 3

Performing a proper penicillin allergy evaluation in the emergency department can have lasting benefits for patients and antimicrobial stewardship.

De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.

De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.

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