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Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de\u2010labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed an evidence\u2010based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de\u2010labeling. Over the period 1928\u20102018 in Pubmed and Medline, search terms used included \u201cpenicillin allergy\u201d or \u201cpenicillin hypersensitivity\u201d alone or in combination with \u201cadverse events,\u201d \u201ctesting,\u201d \u201cevaluation,\u201d \u201ceffects,\u201d \u201clabel,\u201d \u201cde\u2010labeling,\u201d \u201cprick or epicutaneous,\u201d and \u201cintradermal\u201d skin testing, \u201coral challenge or provocation,\u201d \u201ccross\u2010reactivity,\u201d and \u201cantimicrobial stewardship\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operationalizing penicillin allergy de\u2010labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de\u2010labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/all.13848","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T13:36:18Z","timestamp":1556804178000},"page":"273-288","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":242,"title":["The challenge of de\u2010labeling penicillin allergy"],"prefix":"10.1111","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1888-4188","authenticated-orcid":false,"suffix":"Jr","given":"Cosby A.","family":"Stone","sequence":"first","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Trubiano","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Austin Health Heidelberg Victoria Australia"},{"name":"Department of Infectious Diseases Centre for Antibiotic Allergy and Research, Peter MacCallum Cancer Centre Melbourne Victoria Australia"},{"name":"Department of Medicine (Austin Health) University of Melbourne Parkville Victoria Australia"},{"name":"The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine R. 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