2026 Eastern States Conference

Authors: Kyle Greenfield PharmD, Carina Mackarey Pharm D

Learning Objective: At the completion of this presentation, the participant will be able to identify components of pharmacist-led beta-lactam allergy assessment that support appropriate antibiotic selection.

Background: Many reported beta-lactam allergies represent low-to-moderate risk reactions that limit first-line therapy. This project evaluated whether pharmacist-led assessments could clarify allergy histories and support appropriate antibiotic selection.

Self-Assessment Question: Which finding most strongly supports safe beta-lactam use in a patient with a documented penicillin allergy?

Methods: This prospective quality improvement project was conducted at the Wilkes-Barre VA Medical Center from November 2025 through February 2026. Patients admitted to our medical unit (4E), ICU, or those scheduled for surgical procedures with a documented beta-lactam allergy were identified for pharmacist assessment. Patients were interviewed either in person during hospitalization or by phone prior to surgery to clarify the causative beta-lactam, the type of reaction, and any prior tolerance to other beta-lactams. VA and external pharmacy records were reviewed to identify previous beta-lactam exposures. Findings were documented in a standardized “Beta-lactam Allergy Assessment Note” and allergy records were updated when appropriate to support future antibiotic selection.
 
Results: A total of 42 patients with documented beta-lactam allergy labels were assessed including 10 surgical patients. Penicillin allergy labels were present in 36 patients (86%). All 10 surgical patients received clindamycin for prophylaxis; however, 5 (50%) had documented prior beta-lactam tolerance and could have safely received cefazolin. Following assessment, 9 patients (21%) had their allergies de-labeled, 30 (72%) were eligible for an oral amoxicillin challenge, and 3 (7%) required continued beta-lactam avoidance. Most patients (81%) had low-to-moderate risk reactions. Prior tolerance of at least one beta-lactam antibiotic was identified in 32 patients (76%) and 40 patients (95%) reported reactions occurring more than 10 years prior.

Conclusion: Pharmacist-led beta-lactam allergy assessment identified opportunities to clarify inaccurate allergy labels and support development of an oral amoxicillin challenge protocol. Most hospitalized patients were receiving appropriate beta-lactam therapy; however, opportunities to optimize pre-operative antibiotic selection were identified. Incorporating structured allergy evaluations into antimicrobial stewardship workflow may improve access to first-line therapies and optimize prescribing practices.