Providing an Antibiotic Allergy Service

Approximately 10% of patients report an allergy to ≥1 antibiotics, most commonly penicillins. Having a label of penicillin allergy has important health consequences for the individual, as well as health and economic impact at the population level. Despite this, only a minority of patients have the opportunity to have suspected antibiotic allergies confirmed. Busy clinicians seldom have time to explore the history of suspected antibiotic allergies in detail; an important role of the antibiotic allergy service is to do just this, including gathering contemporaneous notes, charts, and correspondence where necessary. The likelihood of true allergy, the mechanisms of immune hypersensitivity, the approach to testing, and the risk of reexposure to the same or related antibiotics can then be considered. Skin testing remains the mainstay of investigation, with challenge testing generally used to confirm tolerance. A basic knowledge of the frequency with which different drugs cause different hypersensitivity responses and that of the patterns of cross-reactivity between related drugs is very useful to a wide range of clinicians.