Drug Allergy Diagnostics: From Beta-Lactam Delabeling to Antimicrobial Stewardship

Drug allergy diagnosis and penicillin and beta-lactam allergy delabeling are critical areas within allergy and immunology, with wide-reaching implications for clinical care and public health. Drug allergy labels, especially those concerning penicillins and beta-lactams, are prevalent, yet mounting evidence suggests that many are inaccurate or outdated. These erroneous labels can adversely impact prescribing practices, resulting in unnecessary avoidance of first-line antibiotics, escalation to broader-spectrum or less effective alternatives, higher rates of antimicrobial resistance, increased healthcare costs, and compromised patient outcomes. Pioneering research over the last decade has yielded substantial progress in refining diagnostic testing—from improved skin and provocation tests to in vitro assays and risk stratification tools—enabling more precise identification of true drug allergies and facilitating safe delabeling in diverse patient populations. However, challenges persist surrounding the implementation and validation of these tools, especially in varying healthcare environments and among patients with delayed or atypical hypersensitivity reactions, since many of these tools were developed or validated mainly with patients having immediate hypersensitivity.The overarching aim of this Research Topic is to spotlight the latest developments in drug allergy diagnostic strategies and structured pathways for beta-lactam allergy delabeling. It seeks to bring together interdisciplinary research exploring the innovation, validation, and clinical integration of diagnostic tests, particularly in the setting of delayed hypersensitivity reactions; the implementation of effective delabeling protocols; and the translation of these strategies into routine healthcare practice to improve patient safety and promote responsible antibiotic use. Key questions addressed include how to enhance diagnostic accuracy, which protocols are effective across different healthcare settings, and what multidisciplinary approaches best support successful operationalization at scale.This Research Topic is focused on advances, validation, integration, and real-world outcomes of drug allergy diagnostic pathways with an emphasis on penicillin and beta-lactam allergies. We invite submissions that address new diagnostic methods, test validation across diverse populations (including children), strategies for addressing delayed hypersensitivity, and interdisciplinary implementation of delabeling protocols. To gather further insights and drive progress, we welcome articles addressing, but not limited to, the following themes:o Penicillin allergy delabeling protocols and diagnostic pathwayso Beta-lactam allergy diagnostics and cross-reactivity assessmento Skin testing, provocation testing, and in vitro diagnostics for drug allergyo Diagnostic algorithms and risk stratification tools in hospital and outpatient settingso Point-of-care and rapid diagnostic approaches for drug hypersensitivityo Diagnostic challenges in delayed hypersensitivity reactionso Integration of allergy diagnostics into antimicrobial stewardship programso Implementation studies evaluating delabeling programs in healthcare systemso Real-world outcomes of drug allergy testing and delabeling initiativeso Comparative studies evaluating the performance of diagnostic approacheso Pediatric drug allergy labeling, evaluation, and delabeling protocolsSubmissions may include original research, clinical trials, real-world studies, systematic reviews, and perspectives focusing on the development, validation, or implementation of diagnostic tools and clinical pathways. Studies based primarily on computational or secondary data must include appropriate validation. Contributions demonstrating clinical applicability and real-world impact are especially encouraged. Topic editors: Dimitrios Kassimos, Hugo WF Mak, Lisa Avery Source: https://www.frontiersin.org/research-topics/81148/drug-allergy-diagnostics-from-beta-lactam-delabeling-to-antimicrobial-stewardship