Belgian consensus-based recommendations on the management of hospitalized patients with a penicillin allergy label

OBJECTIVES: Penicillin allergy labels are common among hospitalized adults and are frequently inaccurate, potentially leading to inappropriate antibiotic use and avoidable harm. This Belgian consensus-based recommendation aims to provide a pragmatic framework for the management of penicillin allergy labels in hospitalized adults (>18 years), with particular emphasis on distinguishing low- to high-risk labels. METHODS: Recommendations were developed through a structured, multidisciplinary expert consensus process and are presented as a stepwise clinical algorithm. RESULTS: The recommendations highlight a structured approach to evaluate reactions through a series of questions, delineating between severe and non-severe signs. It offers a pragmatic algorithm for managing low-risk penicillin allergy labels through re-administration procedures while ensuring emergency preparedness for rare adverse reactions. Comparisons with existing protocols revealed differences in approaches to delabeling, referral criteria for allergy evaluation, and liberalization of antibiotic choices based on reaction severity, timelines, and individual patient risk factors. The recommendation favors a patient-centric risk-assessment approach, offering distinctions between severe and non-severe reactions and includes precautions based on reaction types and timelines. CONCLUSION: This consensus-based recommendation offers a structured approach to managing penicillin allergy labels in hospitalized adults.