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Delabeling Antibiotic Allergy in the Solid Organ Transplant Population Using a Multiple Antibiotic Allergy Evaluation Strategy
Journal article   Open access   Peer reviewed

Delabeling Antibiotic Allergy in the Solid Organ Transplant Population Using a Multiple Antibiotic Allergy Evaluation Strategy

Rebecca Lee, Grace Koo, Matthew S. Krantz, Christine Allocco, Elizabeth Phillips and Cosby A Stone, Jr
Transplant Infectious Disease, e70099
2025
DOI: https://doi.org/10.1111/tid.70099
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Antibiotic Allergy1.00 MBDownloadView
CC BY V4.0,  Open Access

Abstract

antibiotic allergy label multiple drug delabeling transplant
Background First-line antibiotics, such as penicillins, cephalosporins, and sulfonamides, are critical for preventing infections in immunocompromised solid organ transplant (SOT) patients. However, many patients are labeled with multiple antibiotic allergies (AALs) prior to transplant, increasing their risk of adverse outcomes. Because these patients often travel long distances and follow complex care plans, minimizing the number of drug allergy clinic (DAC) visits is important to avoid disruption and improve care continuity. Methods We conducted a retrospective cohort study of SOT patients evaluated at Vanderbilt University Medical Center outpatient DAC between 2014 and 2024. We assessed the efficacy, feasibility, and efficiency of a multiple antibiotic allergy evaluation strategy (MAAES), where patients with two or more low-risk AALs underwent consolidated evaluation, testing, and oral challenges, with the goal of delabeling as many as three AALs in a single visit. Results Among 184 SOT patients referred for evaluation, the median age was 57 years (IQR 47, 64); 112/184 (61%) were female, and 64/184 (35%) traveled from out-of-state. A total of 53 patients (29%) had two or more first-line AALs. Of these, 49 (93%) had labels successfully removed during their visit: 37 penicillin, 25 cephalosporin, and 24 sulfa allergy labels were delabeled. MAAES reduced the number of required visits to address these AALs by 61%. Conclusions MAAES enabled safe, efficient, and consolidated AAL evaluation and removal in SOT patients. In 57% of patients with ≥ 2 first-line AALs, all were safely delabeled in a single clinic visit, improving care efficiency and antibiotic access.

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Collaboration types
Domestic collaboration
International collaboration
Citation topics
1 Clinical & Life Sciences
1.265 Dermatology - Skin Allergies
1.265.1140 Drug Hypersensitivity
Web Of Science research areas
Immunology
Infectious Diseases
Transplantation
ESI research areas
Immunology
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