Shared Decision-Making and Health-Related Quality of Life in Drug Allergy

Shared decision-making (SDM) is a cornerstone of patient-centered care that integrates clinical expertise with patient values to guide healthcare decisions. In drug allergy, SDM is particularly critical due to the inherent need of balancing risks of intervention (eg, skin testing, rechallenge, or desensitization) and risks of avoidance (eg, second-line therapies and for patients with antibiotic allergy, increased costs, suboptimal treatment, and antimicrobial resistance). Patients carrying drug allergy labels, including both survivors of severe reactions and those with unverified drug allergies, have associated reductions in quality of life and overall psychological well-being, often exhibiting heightened anxiety, depression, and distress when taking medications. Recent studies demonstrate that drug allergy evaluation leads to meaningful improvements in quality of life for these patients. However, patient reluctance and concerns remain major barriers to drug allergy evaluation and appropriate treatment. SDM addresses these barriers by facilitating discussions that incorporate patient preferences to foster trust and engagement. Integrating SDM throughout the drug allergy care continuum, from initial labeling to diagnostic evaluation and management, can assist with patient acceptance of recommendations, improved adherence, and ultimately optimized clinical outcomes and quality of life.