Electronic Consultation-Driven Penicillin Allergy Delabeling in Pregnancy.

We evaluated an electronic consultation (e-consult) pathway for penicillin allergy delabeling in pregnancy in a retrospective cohort of patients referred between November 2022 and December 2024. Obstetric clinicians submitted structured allergy histories to allergists who recommended delabeling or in-person evaluation with skin testing and/or oral challenge. Among 117 patients, 60% were delabeled overall, and 82% completing evaluation were delabeled. Delabeling occurred via history (23%), skin testing (21%), and direct oral challenge (56%), and antibiotic therapy changed in 21% of patients. In multivariable models, private insurance was associated with higher odds of delabeling (OR 3.72, 95% CI 1.55-8.89). Our work supports e-consults for efficient risk stratification and direct oral challenge in low-risk patients.