Antibiotic allergy delabeling is a core stewardship strategy that reduces resistance and improves patient outcomes nationwide.
Why Inaccurate Labels Matter
Antibiotic allergy labels are common across care settings, especially for beta-lactams. In high-income countries, up to 11.5% of adults report a penicillin allergy, and prevalence can approach 35% in hematology, oncology, and transplant populations. More than 90% of these labels are inaccurate, yet they drive avoidable harm. Patients with antibiotic allergy labels face higher risks of Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, surgical site infection, intensive care admission, prolonged hospitalization, and increased mortality. They are also more likely to receive broader-spectrum agents from World Health Organization Watch or Reserve categories, which amplifies antimicrobial resistance and complicates future treatment choices.
Antibiotic Allergy Delabeling In Practice
The review positions antibiotic allergy assessment and delabeling as essential to infectious diseases and antimicrobial stewardship practice. It emphasizes structured risk stratification that distinguishes low-risk, patient-reported reactions from severe immunoglobulin E and T-cell–mediated reactions. Multidisciplinary collaboration among infectious diseases physicians, antimicrobial stewardship pharmacists, internal medicine clinicians, and community providers supports safe evaluation, including supervised test dosing when appropriate. This coordinated approach restores access to first-line beta-lactams, reduces unnecessary exposure to second-line agents, and shortens time to effective therapy. By correcting inaccurate labels, antibiotic allergy delabeling strengthens guideline-concordant prescribing and reduces downstream complications associated with suboptimal antimicrobial choices.
Clinical Implications For U.S. Practice
Embedding antibiotic allergy delabeling into routine pathways can improve care quality and public health across hospitals and clinics. Accurate histories, standardized risk tools, and clear referral criteria enable timely decisions at admission, in perioperative planning, and in outpatient care. As more patients are safely delabeled, clinicians can prescribe narrower-spectrum antibiotics with confidence, advance antimicrobial stewardship metrics, and mitigate antimicrobial resistance pressure. For infectious diseases physicians, antimicrobial stewardship pharmacists, and frontline internal and community medicine providers, antibiotic allergy delabeling offers a practical, evidence-based route to restore first-line therapy, optimize outcomes, and reduce preventable harm. The review provides a framework that empowers teams to address inaccurate labels systematically, aligning clinical practice with patient safety and stewardship goals.
Reference: Mitri EA et al. Executive Summary: State-of-the-Art Review: Antibiotic Allergy-A Multidisciplinary Approach to Delabeling. Clin Infect Dis. 2025;81(4):693-694.
