Prioritisation of antimicrobial allergy testing

Ideally, all patients who report antimicrobial hypersensitivity should have allergy testing to verify their allergy. Take an extensive allergy history first (see Questions to ask patients reporting antibiotic allergy) to ascertain if it is appropriate to directly delabel a patient’s allergy.

Allergy testing is not universally available to clinicians and patients, so testing should be prioritised in patients who are most likely to benefit from confirmation of allergy; for example those who:

• require more than 2 weeks of antibiotics for high-morbidity or -mortality infections (eg endocarditis)
• require frequent courses of antibiotic therapy (eg oncology patients, haematology patients, patients with cystic fibrosis)
• require long-term antibiotic therapy (eg patients without a functional spleen)
• are undergoing surgery associated with a high risk of infection where antibiotics may be required perioperatively
• have an infection for which penicillins are the most appropriate antibiotic
• are allergic or intolerant to multiple antibiotics
• have primary or secondary (acquired) immunodeficiency, or who are on significant immunosuppressive therapy.