Penicillin Allergy, Really?—A Cross-Sectional Mixed-Methods Study in Baden-Württemberg, Germany, to Explore General Practitioner Perspectives on Delabeling Potential in Primary Care

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Abstract
Background: Most penicillin allergy labels are documented in early childhood and re-sult from events of low risk for allergy. In Germany, evidence-based strategies to eval-uate likelihood of a true penicillin allergy are still lacking. As general practitioner in-put is indispensable regarding required resources for an implementation of successful delabeling strategies in outpatient care, a mixed-methods study in Ba-den-Württemberg, Germany explored untapped delabeling potential and conditions for successful initiatives based on their experiences. to support preservation of penicil-lin as a treatment option and prevent resistance development. Methods: A cross-sectional convergent mixed-methods study was conducted with an online survey and semi-structured interviews. The survey link and invitation to participate in an in-terview was sent to randomly selected publicly available e-mail addresses. Survey data were analyzed descriptively. Qualitative data were analyzed inductively based on thematic analysis. Results: N=101 survey questionnaires and n=15 interviews were analyzed regarding relevance, experiences, framework conditions, and potential ap-proaches to delabeling. All participants had patients with limited recollection of the index reaction. Most participants considered delabeling a highly relevant topic in gen-eral practice. Delabeling efforts were discouraged by lack of time, expertise, and re-muneration, and uncertainty due to missing guidelines. Taking a sufficient medical history and, if necessary, subsequent testing were seen as one approach to delabeling. For a standardized approach in primary care, patient and care provider education, precise guideline recommendations, and delabeling expert teams were suggested. Conclusion: The findings mirror aspects already identified in international research. A nationwide survey with general practitioners could confirm that addressing necessary resources and systemic adjustments would support effective penicillin allergy delabel-ing in outpatient care.
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