Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance

Area of Science:

• Clinical Immunology
• Pharmacology
• Infectious Diseases

Background:

• Antibiotics are frequently prescribed, yet antibiotic allergy is the most common self-reported drug allergy.
• Over 90% of patients labeled with antibiotic allergy are not truly allergic.
• The antibiotic allergy label negatively impacts antimicrobial stewardship, leading to broad-spectrum antibiotic use and resistance.

Purpose of the Study:

• To review methods for accurate antibiotic allergy diagnosis and de-labeling.
• To highlight the public health implications of inaccurate antibiotic allergy labeling.
• To guide the selection of appropriate diagnostic approaches.

Main Methods:

• Review of current diagnostic methods for antibiotic allergy, including clinical history, in vitro tests (immunoassays, basophil activation tests), and in vivo tests (drug provocation, skin tests).
• Discussion of the limitations and benefits of each diagnostic approach.
• Emphasis on the need for specialized healthcare professionals and a multidisciplinary approach.

Main Results:

• Clinical history alone is often insufficient for de-labeling.
• In vitro tests have limitations in sensitivity and availability.
• In vivo tests, while effective, carry inherent risks and require expert interpretation.
• Diagnostic approaches vary internationally due to differing antibiotic consumption patterns.

Conclusions:

• Accurate diagnosis is crucial for de-labeling patients mislabeled as antibiotic allergic.
• A combination of diagnostic methods, often including in vivo testing, is necessary for successful de-labeling.
• A multidisciplinary approach is recommended to mitigate risks associated with antibiotic allergy labels, particularly for penicillin.