This review examines barriers that prevent general outpatient pediatric providers from delabeling patients with low-risk penicillin allergy. It provides a summary of current progress and offers insight into potential solutions to improve clinical implementation. Unverified penicillin allergy, often labeled in early childhood, are associated with adverse health outcomes and increased healthcare costs over time. Consequently, the focus has shifted to the general pediatric setting for identifying and delabeling low-risk allergy. This review concentrates on key factors influencing implementation in outpatient pediatrics, including the need for standardized, validated pediatric-specific protocols; the perceptions and education of patients and medical staff; environmental and social determinants of health; and economic and logistical challenges. This review identifies the primary obstacles to effective outpatient delabeling as knowledge gaps among providers, patient and family apprehension, systemic healthcare challenges, and disparities in allergy care resources. Overcoming these barriers will require a multi-faceted approach that includes structured education, the adoption of validated low-risk penicillin allergy delabeling strategies for pediatric patients, and policy-driven changes to healthcare delivery. These efforts are essential for improving outcomes for pediatric patients labeled with a history of penicillin allergy. This review provides practical insights and solutions to barriers faced in the general outpatient pediatric implementation of low-risk penicillin allergy delabeling.
Mari et al. (2026) studied this question.