A recent qualitative study maps 6 barriers to penicillin allergy delabeling onto 8 concrete strategies primary care practices can adopt, from non-physician-led conversations to EHR-based flagging tools.¹

Investigators drew on 119 interviews and focus groups conducted across 3 Boston hospital networks, including Brigham and Women's Hospital, Massachusetts General Hospital, and Tufts Medical Center, using the CFIR-ERIC Implementation Strategy Matching Tool to translate patient and clinician interview data directly into actionable tactics. Barriers included clinicians avoiding penicillin allergy conversations, patients reporting they were never asked about their allergy, language and cultural factors, time constraints, perceived risk in delabeling, and limited allergist access.¹

Mapping the 5 ERIC strategies produced 8 specific tactics, including:

1. Involve nonphysician clinicians
2. Expand urgent care access for post-delabeling testing
3. Support non-English-speaking patients in finding safe delabeling opportunities
4. Translate clinical champions into primary care champions
5. Use data experts to automate the identification of patients who safely received penicillin despite an active label
6. Speed up allergy e-consultations
7. Incentivize delabeling (billing, pay-for-performance)
8. Educate patients and clinicians on the concept

The research team is now developing a shared decision-making worksheet clinicians could use directly with patients during a visit. The tool is designed to walk through common facts and misconceptions about penicillin allergy in an accessible, single-page format.

All clinics in the study used Epic as their electronic health record, researchers noted. This shared platform could support future EHR-embedded reminders and asynchronous messaging tools.¹

HCPLive spoke with Alysse Wurcel, MD, of Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, about which of these 8 strategies are feasible today and what she tells clinicians who feel too pressed for time to raise the topic.

Q&A: 8 Strategies to Improve Access to Penicillin Allergy Delabeling

HCPLive: How much of clinicians' fear about incorrectly removing a label is grounded in actual clinical or legal risk versus perception?

Wurcel: I’ve never seen someone [who was] truly allergic to penicillin in my life. I think they truly exist, and it's a very scary experience, [but] I don't think the average clinician who's fearful about going through delabeling has ever seen anyone [with] a penicillin allergy.

It's more we live in a very litigious society, and the idea that you knew that someone had a penicillin allergy and you proceeded with delabeling, [may lead to the] consequence of being sued, rather than the actual truth of the likelihood: that the person would have a terrible reaction necessitating intubation.

HCPLive: Of the 8 strategies from the five ERIC domains, which is most feasible for practices to adopt now without new funding or infrastructure?

Wurcel: Anything that's digitally or electronically based is the right way to go. Clinical documentation advisories or reminders embedded into the EHR, although kind of annoying for the average clinician, have been shown to change practice. That's the 1 that I think is most likely to help.

HCPLive: How close is the EHR-based strategy to being deployable today?

Wurcel: Our team is working on it, [as] part of this grant. The whole question is whether, if you put [something] into place in an EHR reminding clinicians to talk about penicillin allergy, is it going to just be the 10th thing on that list of things to discuss for that primary care doctor? Is it going to be ignored? Why should the clinician actually use it? That's the harder. It's easy to make it, but it's harder to make it in a way that will actually change [clinical] practice.

HCPLive: What's the next step for this research? Are you planning to pilot or test any of these eight strategies directly?

Wurcel: That is our hopeful next step. We are starting to develop shared decision-making tools because what we learned is that clinicians don't feel comfortable talking with patients [about penicillin allergy]. We've started the process of developing a sheet of paper that the doctor could walk through with the patient [to discuss] facts and misunderstandings about penicillin allergy.

HCPLive: What would you say to a clinician who feels they simply don't have the bandwidth to add this to an already-packed visit?

Wurcel: I hear you. I am that clinician, so you're not alone. I don’t think it has to be every patient’s visit. If you're seeing 20 patients in a day and notice 1 has a penicillin allergy, I would see it as a victory for talking about that penicillin allergy.

There's something to be said for just saying, “I know we have a lot of things talking about today, but I just want to let you know, most people with penicillin allergies don't really have them. What do you think about that?” Just trying to put in 1 sentence or [having] the goal of talking about it with 1 patient every day creates small measures of success that will then go into habit.

HCPLive: Is there anything else you'd like to highlight about this study?

Wurcel: What's interesting about penicillin allergy is that it sits at the intersection of implementation science and de-implementation science. Implementation science is about putting something into place; de-implementation science [is about taking] something harmful out. This study is at the intersection between implementation science, where we're putting something into place, and de-implementation science, where we're trying to remove incorrect allergies, and that's why I think it's really exciting.

Read part 1 of the Q&A with Wurcel here: Q&A: 6 Barriers to Penicillin Allergy Delabeling, With Alysse Wurcel, MD

References

1. Wurcel A, Crabtree D, Asupoto O, et al. Strategies to increase equitable access to penicillin allergy de-labeling interactions: a qualitative multi-center study. JAMA Open. doi:10.1001/jamanetworkopen.2026.33825

2. Wurcel A. Q&A: 6 Barriers to Penicillin Allergy Delabeling, With Alysse Wurcel, MD. HCPLive. Published September 15, 2026. Accessed September 15, 2026. https://www.hcplive.com/view/6-barriers-penicillin-allergy-delabeling-wurcel