Penicillin Allergy Impact and Management

The assessment and testing of beta-lactam allergy has transformed into a new pillar of antimicrobial stewardship. There are demonstratable links between beta-lactam allergy, and in particular penicillin allergy, with poor prescribing, antimicro-bial resistance, and inferior patient outcomes. Subsequent integration of beta-lactam allergy cross-reactivity principles into international therapeutic guidelines has improved the utilization of alternative beta-lactams in those reporting a primary penicillin allergy, based on the core principles of side-chain cross-reactivity. Further, the focus on delabeling as a primary stewardship intervention in the outpa-tient and inpatient space has elevated this intervention as a "weapon" of AMS pro-grams using a wide stakeholder group and range of testing strategies (PST, cephalosporin skin testing, and direct oral challenge). The current body of evidence supports the integration of beta-lactam allergy assessment and delabeling into cur-rent AMS practice.