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Multiple Antibiotic Allergy Evaluation Strategy (MAAES): A Comparative Effectiveness Study
Journal article   Open access

Multiple Antibiotic Allergy Evaluation Strategy (MAAES): A Comparative Effectiveness Study

Thanaporn Ratchataswan, Rebecca Lee, Amir Asiaee, Matthew Krantz, Grace Koo, Cosby A Stone, Jr and Elizabeth Phillips
The Journal of Allergy and Clinical Immunology: In Practice, In Press
2026
DOI: https://doi.org/10.1016/j.jaip.2026.07.005
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Open Access CC BY-NC-ND V4.0

Abstract

Background Inaccurate multiple antibiotic allergy labels to first-line agents (penicillins, cephalosporins, and sulfonamides) restrict optimal therapy and often require sequential evaluations across multiple visits, delaying delabeling and increasing loss to follow-up. Objective To conduct a comparative effectiveness study of the Multiple Antibiotic Allergy Evaluation Strategy (MAAES), comparing its effectiveness, safety, and patient-reported outcomes (PRO) to traditional sequential evaluation (non-MAAES). Methods This retrospective cohort study (2014–2024) compared same-day multi-antibiotic testing (MAAES) with non-MAAES in patients with ≥2 low-risk labels. Multivariable regression adjusted for baseline differences and testing era. Inverse probability of treatment weighting (IPTW) and a restricted post-2020 subcohort analysis addressed selection bias and temporal shifts. Outcomes included delabeling efficacy, time to complete delabeling, loss to follow-up, relabeling, adverse events (AEs), and PRO. Results Baseline differences were present between the MAAES and non-MAAES groups, including penicillin anaphylaxis (1.4%vs.6.6%, p=0.002), angioedema (12.4%vs.19.1%, p=0.049), maculopapular rash (13.1%vs.24.3%, p=0.002), and unknown sulfonamide history (9.5%vs.3.7%, p=0.03). MAAES removed 97.4% of labels vs 79.6% for non-MAAES (adjusted odds ratio(aOR) 9.41, 95%CI 5.22-16.95, p<0.001). MAAES achieved faster complete delabeling (log-rank χ2=42.4, p<0.001), with 84.9%vs.21.1% delabeled at the initial visit (restricted mean survival time difference: 2.1 months). Results remained robust in post-2020 and IPTW models. Loss to follow-up (1.3%vs.17.2%; aOR 0.06, 95%CI 0.03–0.13; p<0.001) and AEs (<1%vs.2.8%; aOR 0.26, 95%CI 0.09–0.78; p=0.02) were significantly lower with MAAES. Favorable PRO was sustained, with no significant differences between groups. Conclusions A consolidated multi-drug evaluation strategy substantially improves effectiveness of first-line antibiotic allergy delabeling while maintaining excellent safety profiles and PRO.

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