Shedding Misconceptions: The importance and impact of Drug allergy de-labelling

Abstract

Correctly labelling antibiotic allergies has become essential to global antimicrobial stewardship due to rise in multi-drug resistant organisms.

Drug hypersensitivity reactions are often misunderstood, leading to misconceptions that can both hinder effective medical treatment and contribute to patient anxiety. It leads to avoidance of drugs with label of allergy and prescription of other broad spectrum antibiotics which can be contributing to antimicrobial resistance, economic burden to the patient and the healthcare system. By the process of de-labelling, we can be championing for antimicrobial stewardship.

De-labelling often involves a structured approach, including a detailed medical history, assessment of the initial allergic reaction, and consideration of potential testing, such as skin tests or supervised drug challenges. It is a collaborative effort, requiring expertise from allergists in combination with the patient's healthcare team, leading to improved patient care and reduced constraints on medication choices.

Informed consent and shared decision-making with patients are essential when deciding which medications to delabel first and weighing the advantages/disadvantages of testing against the temporary use of substitute antibiotics.

If these evaluations show that a patient can safely tolerate a drug they were previously labelled allergic to, the allergy label is removed, or de-labelled, it can pave the way forward to use it in future if required.

Recent initiatives have focused on patients with beta lactam allergy and high risk populations that may require these antibiotics as first line treatment, as they are believed to be the most likely to benefit from the removal of false antibiotic allergy labels. An overview of current risk stratification techniques along with a summary of how various delabeling programs have applied these ideas to their delabeling algorithms is given in this review.