Figure 1: Beta-lactam antibiotic allergy assessment tool.

Note: Patients classified as an “immediate hypersensitivity” are appropriate for desensitization if the patient has a beta-lactam allergy history and requires urgent penicillin based therapy

Abbreviations: SCAR, severe cutaneous adverse drug reactions, DRESS, drug reaction with eosinophilia and systemic symptoms, AIN, acute interstitial nephritis, DILI, drug-induced liver injury, ULN, upper limit normal

^a In the appropriate setting a direct oral rechallenge may be performed under specialist guidance

^b Skin testing followed by oral rechallenge can be performed in the outpatient or inpatient setting. Those patients with features of severe life threatening allergy are those marked for “outpatient assessment” rather than inpatient setting to ensure a (i) detailed collateral history is obtained, (ii) presence of specialist allergy oversight and (iii) resolution of acute illness. If the aforementioned can be achieved in the acute setting then testing may proceed with caution.