title: Antimicrobial stewardship's new weapon? A review of antibiotic allergy and pathways to 'de-labeling'.
abstract: OBJECTIVE
  The continued emergence of multiresistant pathogens and widespread antimicrobial use has led to a greater emphasis on antimicrobial stewardship programs. Concurrently, an increased awareness of the rising number of antibiotic allergy labels and impact on antimicrobial use has surfaced. The integration of antibiotic allergy de-labeling and antimicrobial stewardship programs may be a pathway worthy of further focus and investigation.
  
  
  RESULTS
  Recent literature has evaluated the efficacy of antibiotic allergy management (historical de-labeling, in-vitro testing, skin prick testing, intradermal testing, and oral challenges) and impact of antibiotic allergy labels on patient outcome. The importance of true and perceived antibiotic allergy cross-reactivity in the setting of β-lactam allergies has been highlighted. The impact of dedicated antibiotic allergy de-labeling clinics, inpatient antibiotic allergy testing, and integrated antimicrobial stewardship programs has been recently appraised.
  
  
  CONCLUSIONS
  More recent literature supports that appropriate antibiotic allergy in-vitro and in-vivo testing and subsequent antibiotic allergy de-labeling, particularly in regard to β-lactams, can decrease broad-spectrum antibiotic use, costs, patient length of stay, and mortality. Integration of antibiotic allergy management into the decision support systems of inpatient and outpatient antimicrobial stewardship programs represents an important opportunity to further improve measured outcomes from antibiotic utilization.
authors.affiliation: aDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria bThe Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia cDepartments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Trubiano
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Phillips
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000276:immunology; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents