Evaluation of Suspected Antibiotic Allergies

Antibiotic-associated adverse drug reactions are often mild (eg, nausea or diarrhea) and typically occur 1 to 6 hours after drug exposure. IgE-mediated reactions cause urticaria, angioedema, bronchospasm, or, in severe cases, anaphylaxis. Cell-mediated delayed hypersensitivity can occur over days to weeks, most commonly as benign cutaneous morbilliform eruptions, although more severe manifestations, such as Stevens-Johnson syndrome, may occur.

The guideline provides evidence-based recommendations for evaluating possible drug allergy in nonsteroidal anti-inflammatory drugs, chemotherapies, immune checkpoint inhibitors, biologic agents, and excipients (inactive substances formulated with pharmaceuticals). This JAMA Clinical Guidelines Synopsis focuses on practice recommendations for antibiotic allergy evaluation.