Effect of Providing Stratification of Low Risk Penicillin Allergies on Penicillin Allergy Label Removal in ICU Setting

Currently it is estimated that at least 25 million people in the United States are labeled as
penicillin allergic although less than 1.5 million of these are truly allergic. Although
combined skin testing and oral challenge is an evidence-based de-labeling strategy the high
burden of penicillin allergy labels means these services are available only through specialty
allergy practices. There is therefore a need to provide evidence for alternative penicillin
de-labeling strategies such as direct oral challenge. Previous studies have utilized
quasi-experimental designs. Test dose challenges are currently recommended as a strategy for
removal of low risk drug allergies, but the current experience is limited to single arm
observational studies and evidence-based strategies for identifying low risk patients are
lacking. The investigators objective is to demonstrate the benefit of providing risk
stratification in removing penicillin allergy labels for low risk penicillin allergy patients
in a randomized controlled trial.