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Drug Allergy Delabeling Programs: Recent Strategies and Targeted Populations

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Abstract

Drug allergy delabeling programs have become an essential element of antibiotic stewardship. Development of delabeling programs involves careful selection of target patient population, thoughtful design of delabeling approach, stakeholder engagement, assembly of key team members, implementation, and evaluation of clinical and safety outcomes. Recent programs have targeted patients thought to be most likely to benefit from removal of inaccurate antibiotic allergy labels, those with β-lactam antibiotic allergies and high-risk populations likely to need β-lactam antibiotics as first-line treatment. This review provides an overview of current risk stratification methods and β-lactam cross-reactivity data and summarizes how different inpatient and outpatient delabeling programs have used these concepts in delabeling algorithms. β-Lactam delabeling programs for inpatients, pediatric patients, and programs utilizing telehealth have been implemented with good outcomes. This review also focuses on delabeling programs for high-risk populations likely to benefit from first-line β-lactam antibiotics. These populations include perioperative, prenatal, and immunocompromised patients. Delabeling programs have been successful in the inpatient and outpatient settings at enabling appropriate antibiotic use. This article reviews delabeling strategies utilized by these programs with a focus on highlighting elements key to their success and future areas for innovation.

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Abbreviations

A/I:

Allergy/immunology

AAAAI:

American Academy of Allergy Asthma Immunology

ACOG:

American College of Obstetricians and Gynecologists

ADR:

Adverse drug reaction

ASP:

Antimicrobial stewardship program

β-Lactam:

Beta-lactam

CDC:

Centers for Disease Control and Prevention

C. diff :

Clostridium difficile

CF:

Cystic fibrosis

C-section:

Cesarean section

EHR:

Electronic health record

GBS:

Group B Streptococcus

HIV:

Human immunodeficiency virus

HSCT:

Hematopoietic stem cell transplant

HSR:

Hypersensitivity reaction

ID:

Infectious disease

IDSA:

Infectious Diseases Society of America

IV:

Intravenous

MRSA:

Methicillin-resistant Staphylococcus aureus

PA:

Penicillin allergy

PCN:

Penicillin

PJP:

Pneumocystis jirovecii Pneumonia

PPROM:

Preterm premature rupture of membranes

RA:

Rheumatoid arthritis

SLE:

Systemic lupus erythematosus

SJS/TEN:

Stevens–Johnson syndrome/toxic epidermal necrolysis

ST:

Skin test

UK:

United Kingdom

US:

United States

VRE:

Vancomycin-resistant enterococcus

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  1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code UHN67, Portland, OR, 97239, USA

    Karen M. Anstey

  2. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA

    Lulu Tsao & Iris M. Otani

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  1. Karen M. Anstey
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Anstey, K.M., Tsao, L. & Otani, I.M. Drug Allergy Delabeling Programs: Recent Strategies and Targeted Populations. Clinic Rev Allerg Immunol 62, 484–504 (2022). https://doi.org/10.1007/s12016-021-08913-x

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