AUTHOR=Li Philip Hei , Thong Bernard Yu-Hor 

TITLE=Delabelling multiple antibiotic allergy: Practical issues

JOURNAL=Frontiers in Allergy

VOLUME=Volume 4 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/allergy/articles/10.3389/falgy.2023.1156137

DOI=10.3389/falgy.2023.1156137

ISSN=2673-6101

ABSTRACT=Delabelling penicillin allergy has gained worldwide interest as more than 90% of such drug allergy labels are found to be inaccurate following a full allergy work-up, deprive patients the use of effective first-line penicillin antibiotics and increase the risk of antimicrobial resistance with the use of other extended spectrum non-penicillin antimicrobials. Significant numbers of adult and paediatric patients over time are labelled with multiple penicillin and non-penicillin antibiotic allergies often during inappropriate antimicrobial use, resulting in a label of “multiple antibiotic allergy”. In contrast to delabelling penicillin allergy where oral direct provocation tests can be used for low-risk, mild reactions, and sensitivity/specificity/positive and negative predictive values of skin tests have been demonstrated, diagnostic tests for multiple antibiotic allergy often require the use of a combination of in-vivo and in-vitro tests across different antimicrobial classes for evaluation. Shared decision making with patients and informed consent are also needed when prioritising which drugs to delabel first, balancing the risks, benefits of testing versus interim use of alternative antibiotics. Similar to delabelling penicillin allergy, the cost-effectiveness of delabelling multiple drug allergies is unknown.