Controversies in Drug Allergy: Drug Allergy Pathways

Anca M. Chiriac, Aleena Banerji, Rebecca S. Gruchalla, Bernard Y.H. Thong, Paige Wickner, Paul Michel Mertes, Ingrid Terreehorst, Kimberly G. Blumenthal

Research output: Contribution to journalReview articlepeer-review

39 Scopus citations


Drug allergy pathways are standardized approaches for patients reporting prior drug allergies with the aim of quality improvement and promotion of antibiotic stewardship. At the International Drug Allergy Symposium during the 2018 American Academy of Allergy, Asthma, and Immunology/World Allergy Organization Joint Congress in Orlando, Florida, drug allergy pathways were discussed from international perspectives with a focus on beta-lactam allergy pathways and pragmatic approaches for acute care hospitals. In this expert consensus document, we review current pathways, and detail important considerations in devising, implementing, and evaluating beta-lactam allergy pathways for hospitalized patients. We describe the key patient and institutional factors that must be considered in risk stratification, the central feature of pathway design. We detail shared obstacles to widespread beta-lactam allergy pathway implementation and identify potential solutions to address these challenges.

Original languageEnglish (US)
Pages (from-to)46-60.e4
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2019


  • Adverse drug reaction
  • Allergy
  • Beta-lactam
  • Drug
  • Graded challenge
  • Guideline
  • Hypersensitivity
  • Penicillin
  • Policy
  • Quality improvement
  • Skin test
  • Stewardship
  • Test dose

ASJC Scopus subject areas

  • Immunology and Allergy


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