Nuevos enfoques para clínicas ambulatorias de alergia a antibióticos

Antibiotic allergy labels, especially to penicillins, are common but often inaccurate, with more than 90% disproven upon formal evaluation. These unverified labels lead to suboptimal antibiotic use, increased healthcare costs, and worse clinical outcomes. Traditional allergist-led assessment models are not scalable due to global shortages of allergy specialists. Recent evidence supports a shift toward proactive, ambulatory, multidisciplinary delabelling strategies that integrate risk-stratified direct oral drug provocation testing into routine care. Validated point-of-care tools now enable non-allergists, including pharmacists, nurses, and physicians, to safely identify low-risk patients suitable for delabelling without skin testing. Successful programs in hospitals, outpatient clinics, and community settings demonstrate that ambulatory delabelling is safe, cost-effective, and scalable. High-yield populations such as pregnant women, immunocompromised individuals, and older adults benefit significantly from timely evaluation. Effective implementation requires structured training, standardized protocols, integration into electronic health records, and a Hub-and-Spoke model linking non-specialist "spokes" to allergist-led "hubs" for oversight. Clear documentation, patient education, and post-challenge follow-up are essential to prevent re-labelling. Future efforts must focus on equitable access, workforce development, and research to validate tools in underrepresented populations and quantify long-term antimicrobial stewardship benefits. Ambulatory delabelling is no longer the sole domain of allergists but a shared responsibility across healthcare systems to improve prescribing, patient safety, and global antimicrobial resistance outcomes.