Pharmacist-led penicillin allergy interventions and delabeling outcomes: a scoping review
Ceren Mandacı, Emre Kara, Gökhan MetanAbstract
Background:
Penicillin allergy is the most frequently reported drug allergy, yet most labels are inaccurate or no longer clinically relevant. Mislabeling may lead to avoidance of beta-lactam antibiotics, suboptimal antimicrobial therapy, increased healthcare costs, and potential contribution to antimicrobial resistance. Pharmacists increasingly contribute to antimicrobial stewardship programs; however, their role in penicillin allergy evaluation and delabeling has not been comprehensively synthesized.
Objective:
To map pharmacist-led or pharmacist-involved interventions aimed at clarifying inappropriate penicillin allergy labels and to describe reported antimicrobial stewardship–related outcomes.
Methods:
This scoping review followed the PRISMA extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science were searched for English-language studies evaluating pharmacist-led or pharmacist-involved penicillin allergy interventions among adults receiving systemic antibiotics.
Results:
Of 1,269 records screened, 15 studies met the inclusion criteria. Interventions most commonly included structured allergy history assessment and risk stratification, education of healthcare professionals, and facilitation of penicillin skin testing and oral drug provocation testing. Pharmacist involvement was frequently associated with increased beta-lactam prescribing and reduced use of broad-spectrum alternatives. Several studies also reported shorter hospital length of stay and lower healthcare costs compared with usual care.
Conclusions:
Pharmacist involvement in penicillin allergy evaluation may help optimize antimicrobial therapy and strengthen antimicrobial stewardship efforts. Integration of pharmacists into allergy assessment workflows may improve the accuracy of allergy documentation and facilitate appropriate beta-lactam use. Further research is needed to evaluate long-term clinical, economic, and implementation outcomes across diverse healthcare settings.