Recommendation

Strength

Quality of evidence

4. We recommend that an antibiotic allergy label can be removed directly without allergy testing when one of the following criteria applies

(no / very low risk of antibiotic allergy):

• The culprit drug has been used since the index reaction without occurrence of an allergic reaction.
• The allergy label was solely based on positive family history of allergy or on fear of allergy.
• The reported symptoms are not compatible with an allergic reaction (i.e., GI complaints only, palpitations, blurred vision).
• There was no temporal association between exposure and the onset of symptoms.

Strong

Moderate

5. We suggest that an antibiotic allergy label can be removed directly without previous allergy testing when one of the following criteria applies (very low risk of antibiotic allergy):

• The index reaction was not severe, confined to the skin and occurred in remote adolescence or childhood.
• The patient is not aware of the antibiotic allergy label or cannot recollect clinical signs and symptoms of a reaction at all.

Weak

Low