How antibiotic allergy labels may be harming our most vulnerable patients

Jason A Trubiano, M Lindsay Grayson, Karin A Thursky, Elizabeth J Phillips and Monica A Slavin
Med J Aust 2018; 208 (11): . || doi: 10.5694/mja17.00487
Published online: 18 June 2018

Antibiotic allergy testing programs will ensure that vulnerable patients receive appropriate antibiotic therapy

Antibiotic allergy labels are accumulated by various mechanisms and are often incorrectly self-reported or recorded. Incorrect antibiotic allergy labels frequently persist in community and hospital medical records throughout patients’ health care journeys, either with the phenotype unverified by clinicians or recorded as unknown.1,2 Among a cohort of older Australian general medical inpatients, we identified that 25% had a mismatch between their reported and recorded antibiotic allergy.3 Further, as an additional source of incorrect antibiotic allergy labels, patients with a true immunological basis for antibiotic allergy, such as immediate (IgE-mediated) reactions, may lose reactivity over time.4 Incorrect antibiotic allergy labels often prevent the use of appropriate narrow spectrum penicillin and targeted antibiotic therapies in both community and hospital practice, frequently among the patients most in need.4,5

  • Jason A Trubiano1,2,3
  • M Lindsay Grayson1,3
  • Karin A Thursky2,4
  • Elizabeth J Phillips5
  • Monica A Slavin2,4

  • 1 Austin Health, Melbourne, VIC
  • 2 Peter MacCallum Cancer Centre and National Centre for Infections in Cancer, Melbourne, VIC
  • 3 University of Melbourne, Melbourne, VIC
  • 4 Royal Melbourne Hospital, Melbourne, VIC
  • 5 Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA


We thank Megan Crane for her significant contribution to the manuscript preparation and Michael Sutherland for establishing the Austin Health multidisciplinary antibiotic allergy testing service.

Competing interests:

No relevant disclosures.


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