Patient-Reported Outcomes Following Beta-Lactam Antibiotic Allergy Delabeling in Allergy Work-Up

Background: Beta-lactam antibiotic allergy is one of the most frequently reported drug hypersensitivities. True allergy is rarely confirmed. Inaccurate labeling leads to unnecessary avoidance of beta-lactams, antimicrobial resistance, and increased healthcare costs. Delabeling is mainly evaluated using electronic databases, whereas patient perceptions, quality of life, and real-world barriers remain uncertain. Methods: This cross-sectional, questionnaire-based study included 96 adults with a reported history of beta-lactam hypersensitivity: 46 after successful specialist delabeling and 50 before specialist evaluation. Structured telephone interviews assessed diagnostic pathways, perceived correctness of diagnosis or exclusion, confidence in beta-lactam safety, antibiotic use, and symptom recurrence. Quality of life was assessed using the WHOQOL-BREF questionnaire. Results: Perceived safety of beta-lactam antibiotics was significantly higher in the delabeled group than in the non-delabeled group (7.37 vs. 2.40; p < 0.001). WHOQOL-BREF scores were similar between groups, except for a small difference in the Environment domain, favoring delabeled (p = 0.029) patients. Among delabeled patients, 57% required antibiotics during follow-up; of these, 65% received beta-lactams. In 35% of cases with an indication, physicians withheld beta-lactams despite documented delabeling. Self-reported mild cutaneous symptoms occurred in 18% of patients re-exposed to beta-lactam antibiotics despite delabeling; the significance of this finding needs to be assessed in the future. Conclusions: Patients who underwent beta-lactam allergy delabeling reported greater perceived safety regarding the use of beta-lactam antibiotics, while no significant differences in quality of life were observed. Persistent reluctance among patients and physicians may, however, limit the real-world benefits of delabeling.