De-labeling Beta-lactam in Adult Population

Purpose of review This review summarizes the various strategies used to de-label adults who are considered to be allergic to beta-lactams and focuses on areas for improvement. Recent findings Strategies for de-labeling penicillin allergy are based on the direct challenge, the classical drug allergy work-up, and stratification of a risk of allergic reaction after exposure to beta-lactams. Strategies based on direct ingestion of aminopenicillin without previous skin tests are safe in low-risk patients. The classical allergy work-up with skin tests and drug provocation has been used for cases where immediate reaction (urticaria or anaphylaxis) seems highly likely. Summary The most rational approach involves integrated de-labeling based on a series of modalities combining risk stratification and decision support, using direct challenge testing in low-risk individuals and skin tests with a challenge test for higher-risk patients. Data from the last 20 years show that de-labeling beta-lactam allergy generates considerable benefits for patients and for public health and reduces healthcare costs. In order to optimize resources, priority should be given to patients treated with aztreonam, patients who must see an allergist before surgery, and immunosuppressed patients. Further studies from countries with variations in clinical practice and epidemiology are necessary to assess the economic and health impact of de-labeling penicillin allergy.