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Published on: July 24, 2021

Multiple Antibiotic Allergy Evaluation Strategy (MAAES): A Comparative Effectiveness Study

Thanaporn Ratchataswan1, Rebecca Lee2, Amir Asiaee3

  • 1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.

The Journal of Allergy and Clinical Immunology. in Practice
|July 14, 2026
PubMed
Abstract

Insights

The Multiple Antibiotic Allergy Evaluation Strategy (MAAES) significantly improves antibiotic allergy delabeling rates and speed compared to traditional methods. This approach enhances patient safety and reduces follow-up loss, proving more effective for antibiotic allergy assessment.

Area of Science:

  • Clinical immunology
  • Pharmacology
  • Infectious diseases

Background:

  • Inaccurate antibiotic allergy labels to first-line agents like penicillins and cephalosporins impede optimal treatment.
  • Sequential evaluations for delabeling are time-consuming, leading to delayed care and patient drop-off.

Purpose of the Study:

  • To compare the effectiveness, safety, and patient-reported outcomes (PRO) of the Multiple Antibiotic Allergy Evaluation Strategy (MAAES) against traditional sequential evaluation (non-MAAES).

Main Methods:

  • A retrospective cohort study (2014-2024) compared same-day multi-antibiotic testing (MAAES) with non-MAAES in patients with multiple low-risk allergy labels.
  • Statistical analyses included multivariable regression and inverse probability of treatment weighting (IPTW) to adjust for baseline differences and bias.

Main Results:

  • MAAES achieved a significantly higher delabeling rate (97.4% vs. 79.6%) and faster delabeling (84.9% at initial visit vs. 21.1%).
  • MAAES demonstrated lower rates of loss to follow-up (1.3% vs. 17.2%) and adverse events (<1% vs. 2.8%).
  • Patient-reported outcomes were comparable between MAAES and non-MAAES groups.

Conclusions:

  • A consolidated multi-drug evaluation strategy, MAAES, substantially enhances the effectiveness of first-line antibiotic allergy delabeling.
  • MAAES maintains excellent safety profiles and positive patient-reported outcomes.
  • This strategy offers a more efficient and effective approach to managing antibiotic allergy labels.
Keywords:
Antibiotic allergy labelAntimicrobial stewardshipBeta-lactam allergyCephalosporin allergyDrug allergy delabelingDrug hypersensitivityMultiple drug allergyPenicillin allergySulfonamide allergy

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