Antibiotic allergy: Mislabels, Misinterpretation and Mismanagement

Antibiotics are implicated as one of the most common medications to cause allergic reactions. Further, they account for the highest number of deaths due to drug induced anaphylaxis. Yet, antibiotic allergies are over-reported and most often, patients with a self-reported or recorded antibiotic allergy are not truly allergic when clinically evaluated, tested, and re-challenged. These antibiotic allergy “mislabels” can have devastating consequences on public health as they may result in displacement of the first-line treatment options with increased use of restricted, broad spectrum antibiotics leading to emergence of antibiotic resistance and significantly higher healthcare cost. Owing to the public health implications of inaccurate antibiotic allergy labels, this review aims to include a contextual account on classification, presentation and mechanisms of antibiotic allergy and a practical approach for investigation and management in the attempt to avoid mislabelling, misinterpretation of investigations and mismanagement of patients with antibiotic allergy.