title: Diagnostic challenges, the evaluation of antibiotic allergy.
abstract: OBJECTIVE
  Antibiotic allergy is commonly reported and often challenging to evaluate. This review highlights recent developments in our understanding of antibiotic allergy, primarily surrounding evaluation, and diagnosis of antibiotic allergy. We provide historical context to establish a framework, lending relevance to the latest studies.
  
  
  RESULTS
  Clinicians have typically employed skin testing as a first step in the diagnosis of drug allergy, reserving drug provocation challenge, the gold standard for diagnosis, for those with negative skin tests. Although skin tests have a good negative predictive value, the positive predictive value has never been established. An increasing amount of research is demonstrating that drug provocation challenge is well tolerated as the initial evaluation in patients with non-life-threatening reactions to antibiotics. This research also calls into question the value of skin testing in these patients.
  
  
  CONCLUSIONS
  Skin testing has long been used as the initial investigation in the diagnosis of drug allergy. New research supports that this may not be necessary in all patients, particularly those with non-life-threatening reactions. Further research into the validity of skin testing is required, along with the development of new diagnostic tests for antibiotic allergy.
authors.affiliation: aFaculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador bDivision of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: O'Keefe
authors.forename: Moshe
authors.initials: M
authors.lastname: Ben-Shoshan
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D011237:Predictive Value of Tests; D012882:Skin Tests
chemical_list: D000900:Anti-Bacterial Agents