Novel Approaches to Ambulatory Antibiotic Allergy Clinics.

Cox F, Dowden A, Sousa-Pinto B, Li PH. J Allergy Clin Immunol Pract. 2026 May;14(5):1014-1022.e1. doi: 10.1016/j.jaip.2025.12.013.

Abstract

Hypothetical patient journey illustrating many missed opportunities throughout
a lifetime for evaluation of a penicillin allergy label and the negative impact
of such a label. GYN, Gynecology; OB, osbtretrics; PCP, primary care provider;
STD, sexually transmitted disease; URI, upper respiratory infection.

Antibiotic allergy labels, especially to penicillins, are common but often inaccurate, with more than 90% disproven on formal evaluation. These unverified labels lead to suboptimal antibiotic use, increased health care costs, and worse clinical outcomes. Traditional allergist-led assessment models are not scalable due to global shortages of allergy specialists. Recent evidence supports a shift toward proactive, ambulatory, multidisciplinary delabeling strategies that integrate risk-stratified direct oral drug provocation testing into routine care. Validated point-of-care tools now enable nonallergists, including pharmacists, nurses, and physicians, to safely identify low-risk patients suitable for delabeling without skin testing. Successful programs in hospitals, outpatient clinics, and community settings demonstrate that ambulatory delabeling is safe, cost-effective, and scalable. High-yield populations such as pregnant women, immunocompromised individuals, and older adults benefit significantly from timely evaluation. Effective implementation requires structured training, standardized protocols, integration into electronic health records, and a Hub-and-Spoke model linking nonspecialist “spokes” to allergist-led “hubs” for oversight. Clear documentation, patient education, and postchallenge follow-up are essential to prevent relabeling. Future efforts must focus on equitable access, workforce development, and research to validate tools in underrepresented populations and quantify long-term antimicrobial stewardship benefits. Ambulatory delabeling is no longer the sole domain of allergists but a shared responsibility across health care systems to improve prescribing, patient safety, and global antimicrobial resistance outcomes.

PDF